PubMed Health⌕ Search

Biomedical subjects

S Shuster

Publications and source records attributed to S Shuster.

At least 55 records · Page 3Linked to original sources
PubMed1995

Remission of ordinary psoriasis following a short clearance course of cyclosporin.

We set out to show that the assumption is incorrect that continuous treatment with cyclosporin is necessary in psoriasis, as this tenet forms a basis for current recommended treatment regimens. Sixty patients with mild to moderate plaque psoriasis were allocated at random to treatment with oral cyclosporin 5 mg/kg/day (30 patients) or topical dithranol and ultraviolet B therapy (30 patients) for up to 16 weeks until clear (median time 6 weeks cyclosporin and 8 dithranol), and the times to relapse compared. The patients were seen monthly for up to 8 months, and the severity and the extent of psoriasis were assessed. Relapse, defined as return of psoriasis to 50% of the area at the start of the trial or patient demand for further treatment, was not significantly different between the groups (hazard ratio 1.11, 95% CI 0.55-2.32). No patients suffered a rebound of severe disease and none relapsed in the first 8 weeks after stopping treatment. The relapse rate was higher following cyclosporin from 8 to 28 weeks after treatment and following dithranol from 28 to 34 weeks. The patients with arthritis had a higher median joint severity score at relapse than prior to treatment with cyclosporin. At the end of 8 months, 5 patients treated with dithranol and 8 patients with cyclosporin remained clear, 75% and 67% having relapsed. We conclude that rapid relapse does not occur after clearance of mild to moderate plaque psoriasis with cyclosporin and the relapse rate was no different from dithranol treatment.

Administration, Oral↗
PubMed1995

Preschool health fairs.

In Vancouver, as in most metropolitan areas, families with preschoolers (infants to five-year-olds) are diverse in language, culture, ethnicity, class and socio-economic status. Immigration, transiency, very young families, single-parent families, poverty and rapid land development are characteristic in some areas. Despite this diversity, the community health nurses of the Vancouver health department have a mandate to provide early intervention and health promotion services for the preschoolers of this population. This has proved to be quite a challenge.

Child Welfare↗
PubMed1994

Determinants of nail thickness and length.

The determinants of final nail thickness and length at its point of detachment at the onychodermal band were studied in 20 normal great toe-nails, removed after injury, by correlating measurements of nail thickness, taken at six anatomical points, with length of nail and its lunular (matrical) and ventral nail components. Final nail thickness at the onychodermal band was related to initial thickness of the proximal matrix, and independently to the lengths of the lunula and ventral nail, but not to final nail length. There was an increase in nail thickness with age, particularly in the first two decades; this appeared not to be due to a decrease in frictional loss of nail.

Adolescent↗
PubMed1994

Maintenance treatment with cyclosporin in atopic eczema.

We have studied two reducing-dose regimens intended to minimize toxicity of cyclosporin A (CyA) while maintaining its capacity to control atopic eczema following induction of remission. Twenty-four patients with severe chronic atopic eczema were first treated in a double-blind randomized placebo-controlled cross-over study of CyA (5 mg/kg/day). All 19 who completed the study showed the expected highly significant improvements, compared with placebo, in area involved, erythema, excoriation, lichenification, itch and requirement for topical steroid. In 17 of the 19 patients, control was re-established with CyA 5 mg/kg/day, and they were then re-randomized to stepwise reduction at 2-week intervals in either (i) the dose of CyA given daily, or (ii) the frequency with which the 5 mg/kg dose was given. Fifteen patients (seven continuous reducing dose, eight intermittent fixed dose) completed the planned reduction to either 1 mg/kg/day or 5 mg/kg every fifth day. In both groups the response was sustained despite dose reduction, although control was less good at a continuous dose of 1 mg/kg. Intermittent treatment was as good as or better than continuous reducing dosage in this study, and in both groups there was further deterioration after the drug was stopped. The findings suggest that the dose of CyA required to control atopic eczema is less than that required to achieve remission, and that the therapeutic index can be further improved by alternative dosing strategies. This offers a new approach to maintenance treatment of eczema and other chronic refractory dermatoses.

Adult↗
PubMed1994

Characterization and analysis of skin wealing by computerized non-linear regression.

Weal formation in human skin may be induced by histamine, histamine releasers and other inflammatory mediators. Weals occur spontaneously in chronic urticaria, and in response to frictional pressure in dermographic urticaria. We present an improved method for the analysis of wealing in human skin by the use of non-linear regression. The method has the advantage of speed, and by the use of non-linear regression permits the full characterization of the response curves. The time course of histamine-induced wealing is a double exponential function corresponding to the separate components of weal appearance and disappearance. Dermographic wealing corresponds to an increasing exponential function with increasing pressure. The method of computerized non-linear regression is a considerable advance on previous methods for the analysis of urticarial wealing, the effect of vasoactive agents, and their therapeutic action.

Cetirizine↗
PubMed1993

Age-dependent change in the hyaluronic acid content of the human chorioretinal complex.

OBJECTIVE: Hyaluronic acid (HA) has a key role in the structure and organization of the extracellular matrix. We sought to identify the distribution of HA in human eye tissue with regard to age using a biotinylated HA-binding protein. METHODS: Fetal and adult (from donors ranging from 28 to 94 years of age) eye tissues were fixed less than 24 hours post mortem and embedded in JB-4 medium (Polysciences, Warrington, Pa). Sections of 2-microns thickness were used. Control sections were pretreated either with Streptomyces hyaluronidase or HA-binding protein inactivated by HA. The binding of the protein to HA was detected with avidinbiotin alkaline phosphatase and developed by incubation with naphthol as-mx phosphate and Texas Red Salt (Pierce, Rockford, Ill). RESULTS: Specific staining for HA was observed in fetal eyes in the choroid, Bruch's membrane, sclera, retinal pigment epithelium, and developing retina from the vitreoretinal interface to the inner plexiform layer. Specific staining decreased with age in the choroid, retinal pigment epithelium, and Bruch's membrane. Hyaluronic acid-specific staining was undetectable in tissues from donors over 50 years of age. CONCLUSIONS: The localization of HA in the chorioretinal complex and its disappearance after the fifth decade of life may play a role in aging and age-related retinal disorders.

Adult↗
PubMed1993

Continuous formation of nail along the bed.

To resolve the problem of whether nail is formed continuously along the length of the nail bed as well as by the germinal matrix, nail thickness was measured at six anatomical points along the length of 20 normal big toe-nails removed after injury. Nail water content was constant at 9-10% along the nail length, and the nails did not shrink with dehydration. Approximately 79% of nail thickness was contributed by the nail matrix, and 21% by the nail bed. The rate of nail production was constant at 0.13 mm/mm along the lunula and 0.027 mm/mm along the whole bed from the distal lunula to the point of separation at the onychodermal band; the fractional change in linear growth and thickness showed less variation than absolute change. The continuous production of nail by the bed provides a simple biological solution to the problem of attachment of a continuously moving plate. It provides a source of entry of drugs into the distal nail plate, and a rationale for the use of much shorter courses of antifungal drugs than previously believed possible.

Adolescent↗
PubMed1993

In dermographic urticaria H2 receptor antagonists have a small but therapeutically irrelevant additional effect compared with H1 antagonists alone.

Two studies of the additional effect of an H2 receptor antagonist when given in combination with an H1 antagonist were undertaken in dermographic urticaria. Using a randomized, double-blind, crossover design in 19 patients, a combination of cetirizine (10 mg at night) and ranitidine (150 mg twice daily) was compared with a combination of cetirizine (10 mg at night) and placebo. The addition of ranitidine did not produce any significant difference in linear analogue scores for weal, itch or sleep disturbance. There was a significant depression of the frictional force/wealing response curve with an increase in wealing threshold (P < 0.0001) following the addition of H2 blockade. The wealing threshold was 54.7 +/- 4.4 (mean +/- SEM) g/mm2 for the H1 antagonist alone, and 73.2 +/- 5.7 for the combination of H1 and H2 antagonists. In a second similar study involving nine different patients, comparing terfenadine (120 mg twice daily) with a combination of terfenadine and ranitidine (150 mg twice daily), the weal threshold was 59.8 +/- 6.6 for the H1 antagonist alone, and 73.0 +/- 6.4 for the combination of H1 and H2 antagonists. Thus, in dermographic urticaria, adding an H2 antagonist to treatment with a potent H1 antagonist gives a small, significant reduction in wealing response, but no symptomatic benefit. We conclude that involvement of the H2 receptor in this urticarial disease is minimal, and does not justify the use of H2 receptor antagonists.

Adolescent↗
PubMed1993

The effect of cetirizine on symptoms and wealing in dermographic urticaria.

The effect of cetirizine, 10 mg at night, on dermographic urticaria, was studied in 19 patients. The study design was a randomized, double-blind, crossover comparison with placebo, each treatment being given for 7 days. Patients kept a daily diary of itch and weal severity (100-mm linear analogue scale), and recorded sleep disturbance. The dermographic weal response was measured objectively with a spring-loaded stylus, and the weal threshold calculated from the force/response curve. There was a small, insignificant subjective response to placebo, but no objective response. On cetirizine, the subjective assessment of wealing was reduced from 34.3 +/- 6.7 (mean +/- SEM, 0-100 scale) to 16.8 +/- 4.1 (P = 0.02), itch was reduced from 43.2 +/- 6.6 to 19.4 +/- 4.1 (P = 0.001), and nights disturbed from 46.2 to 8.8% (P = 0.03). There was a shift to the right in the position of the force/response curve, and the wealing threshold increased from 24.6 +/- 3.2 to 54.7 +/- 4.4 g/mm2 (P = 0.00001), but there was no correlation between change in itch scores and wealing threshold. Cetirizine 10 mg daily is an effective treatment in dermographic urticaria, and its usefulness will depend on the prevalence of unwanted effects.

Adolescent↗
PubMed1993

Prevalence of skin and other cancers in patients with psoriasis.

The prevalence of skin and internal malignancies was estimated from the general practitioners' notes of 2247 patients with psoriasis and 4494 age- and sex-matched controls. The prevalence of skin cancer in the psoriatics was 155% that of controls, but this was not significant at the 5% level. Subgroup analysis showed an increase in skin cancers in women (P < 0.05). There was no difference in the age of onset of skin cancers between psoriatics and controls and there was no evidence of a cumulative therapeutic risk. There was no difference in the prevalence of non-skin cancers between psoriatics and controls.

Adult↗
PubMed1993

Topical indomethacin aggravates the weal and flare response in chronic dermographic urticaria: evidence for a new class of histamine receptors.

The effect of topical indomethacin on the weal and flare response was measured in 9 patients with chronic dermographic urticaria. An augmentation of dermographic wealing by topical indomethacin was shown with lowering of the weal threshold from 22.3 +/- 4.7 g/mm2 (mean +/- SEM, n = 9) to 16.4 +/- 3.8 (p < 0.005), but without a change in the shape of the force/response curve. Flare was increased by indomethacin particularly in patients with a greater lowering of the weal threshold. The augmentation of weal and flare by indomethacin in individual patients was not related to the degree of inhibition of UVB erythema in individual patients. These findings indicate that in chronic dermographic urticaria there is an abnormality involving eicosanoid production by a non-cyclo-oxygenase pathway. It is suggested that this acts by augmenting the effect of histamine on a new class of histamine receptor, the definition and antagonism of which should lead to better control of urticarial disease.

Administration, Topical↗
PubMed1992

The route of rapid access of drugs to the distal nail plate.

It has recently been shown that antimycotic drugs have unexpectedly rapid access to distal nail, which we have suggested occurs through the site of continuous ventral nail formation along the nail bed. To exclude the alternative possibility of diffusion through the nail plate, we have measured the effect of topical terbinafine cream in onychomycosis. Sustained outward movement of the fungally affected distal segment was seen in only 2 of 10 measured nails, and there was no change in the mean severity of clinical involvement in 53 nails under study. This excludes significant diffusion of drugs through the nail plate, and we conclude that the route of rapid access is indeed through the nail bed.

Administration, Oral↗
PubMed1992

Skin cancer after renal transplantation: the causal role of azathioprine.

In 167 unselected patients with renal allografts, after a lag of 3.5 years the prevalence of dysplastic keratotic lesions increased linearly by 6.8%/yr and number of lesions also increased. There was no relationship to sun exposure or skin type. Malignancies occurred in 5 patients after 9 years. Viral warts occurred in 42% but prevalence and extent were not related to time after transplantation or keratoses. Comparison with other drugs and diseases suggests malignant keratoses are initiated in two stages by the cytotoxic effect of azathioprine, the role of immunosuppression remaining unproved. Psoriasis and eczema remitted and the prevalence of zoster and fungal disease increased. P. orbiculare (but not P. ovale) infection increased, unlike in other states of immunosuppression, suggesting the organisms are distinct, not transitional, and differently influenced by the different immunodeficient states induced by drugs and disease.

Adolescent↗
PubMed1992

The unexpectedly rapid response of fungal nail infection to short duration therapy.

To test our hypothesis that, by laying down a fungicidal barrier in the growing nail, a short course of antifungal therapy should be effective against onychomycosis, we treated 8 subjects with Trichophyton rubrum nail infection with terbinafine 125 mg b.d. for 14 days. All but one patient showed marked improvement, and 80% of fingernails and 37% of toenails were clinically cured after 6 months. Although this confirmed our prediction, the onset of response measured by outward movement of affected nail and negative cultures from distal nail clippings occurred after as little as 4 weeks. This was too soon for a fungicidal barrier to have grown out and indicates that the drug must have been carried directly into the diseased distal nail, presumably from newly formed ventral nail beneath it. The findings show that 1) short duration therapy, perhaps even a single dose, is possible in fungal nail infections; 2) the ventral nail provides unexpectedly rapid access of drugs to the site of distal disease.

Adult↗
PubMed1992

Topical ketoconazole does not potentiate oral cyclosporin A in allergic contact dermatitis.

Cyclosporin A is an effective drug but its use is limited by its side effects. Since oral ketoconazole inhibits the metabolism of oral cyclosporin, we set out to find out whether topical ketoconazole would enhance the effect in the skin of oral cyclosporin. Five patients with contact allergic dermatitis (CAD) were given a 6-day course of cyclosporin (1 mg/kg/day) and applied 2% ketoconazole cream to an area on one arm and the inert base to the other. Serial dilutions of the relevant allergen were applied to the arms at 3 days for 48 hours, and the responses were measured objectively a day later. There was no significant difference between responses at the two sites, indicating that topical ketoconazole does not enable the dose of oral cyclosporin to be reduced in CAD.

Administration, Cutaneous↗