Medical and psychosocial aspects of psoriasis.
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Biomedical subjects
Publications and source records attributed to T J Buselmeier.
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Following the initial report by Farber and South on nonsurgical nail avulsion with urea ointment and their emphasis that the therapy was not helpful in treating nondystrophic nails, we utilized a similar therapy to treat a sixty-seven year old patient who had severe arteriosclerotic cardiovascular disease and relatively nondystrophic but symptomatic large toenail disease. Because their formulation was ineffective on nondystrophic nails, a formulation with an additive, 20 percent urea and 10 percent salicylic acid preparation was used. After a period of two weeks of occlusive paplication, painless nonsurgical avulsion was achieved. Moderate maceration of surrounding skin was temporary and relatively asymptomatic.
A 54-year-old man had severe psoriasis with associated arthritis for 10 years. Attempts at therapy with tars, topical steroids and a short course of ultraviolet light were unsuccessful. His psoriasis cleared 6 weeks after cardiac surgery requiring cadiopulmonary bypass oxygenation.
A nodule present for many years on the right leg of a 77-year-old woman was excised and studied by light microscopy. An invasive keratinizing basal cell carcinoma associated with metaplastic bone formation, arising within a dermatofibroma, was found.
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Forty-five patients with uremic pericardial effusion were treated with local instillation of nonabsorbable steroid through an indwelling pericardial drainage catheter and followed up from one to 54 months. In these patients previous intensive dialysis and other attempts at control of the effusions were unsuccessful. The average hospitalization for percutaneous therapy was eight days. An asymptomatic internal mammary artery fistula developed in one patient. Another had resolution of her pericardial effusion but not of associated pericardial pain. She subsequently underwent pericardiectomy (stripping), without resolution of her pain. One patient had a recurrence of her effusion six months after therapy. Complications of this technique are rare. The relatively noninvasive drainage and local instillation of a nonabsorbable steroid is almost universally effective.
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Five patients with psoriasis were treated with haemodialysis. Dialysis therapy was initiated for subsequent development of uraemia in three cases. All of these had successful renal transplants without recurrence of psoriasis while being maintained on post-transplant anti-rejection regimens. Two other cases were haemodialysed, not for uraemia but primarily for psoriasis. One case had moderate improvement of psoriasis after twice-weekly dialysis for two months while the second had no objective improvement up to one month after a single haemodialysis treatment.
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