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Biomedical subjects

V R Doherty

Publications and source records attributed to V R Doherty.

16 recordsLinked to original sources
PubMed1995

'Naevophobia'.

In recent years there has been intensive media interest in pigmented lesions and several skin cancer prevention/early detection campaigns. Pigmented lesions may cause great anxiety, although patients are usually reassured once their moles have been examined by a dermatologist. We describe a case in which a young man with multiple pigmented naevi attempted to remove all the lesions himself. This self-mutilation occurred despite his having attended a dermatology clinic.

Adult↗
PubMed1994

Intravascular histiocytosis.

The majority of cases of intravascular lymphomatosis are B-cell lymphomas with only the occasional case being of T-cell type. We report a case of intravascular lymphomatosis in which the proliferating cells were of histiocytic type; the tumour has recurred following treatment.

Aged↗
PubMed1992

Staphylococcus aureus and intra-nasal mupirocin in patients receiving isotretinoin for acne.

Thirty patients commencing isotretinoin for acne were entered into a double-blind, randomized, placebo-controlled trial to investigate the effect of pulsed intra-nasal mupirocin ointment on Staphylococcus aureus colonization and isotretinoin-related side-effects. In both mupirocin and placebo groups there was an increase in isolation of S. aureus throughout the period of treatment with isotretinoin from the anterior nares, facial skin and lips. However, these increases were significantly less in the mupirocin-treated group. A high proportion of all patients suffered inflammatory side-effects of isotretinoin such as cheilitis and nasal vestibulitis, with their maximum severities being recorded 2 months after starting isotretinoin. In spite of the smaller increase in S. aureus colonization in the mupirocin-treated group no difference was demonstrated in either the incidence of specific S. aureus infections (e.g. furunculosis) or the prevalence of isotretinoin-related inflammatory side-effects. Furthermore, no relationship between the presence of S. aureus and the severity of inflammatory side-effects was shown. Streptococcus species were isolated on four separate occasions from four different patients during the study but their pathogenicity was unclear. These findings suggest that although pulsed intra-nasal mupirocin produces a significant reduction in isotretinoin-related staphylococcal colonization, its routine use cannot be justified on the basis of clinical benefit.

Acne Vulgaris↗
PubMed1992

Psoriasis: an audit of patients' views on the disease and its treatment.

This audit aimed to establish the effect of out-patient clinic attendance on patients' attitudes to their psoriasis, its severity and its treatment. A secondary aim was to determine if there was any correlation between the patients subjective concept of disease severity and objective medical assessment. The audit was carried out by means of paired questionnaires completed by patients at their first visit to the out-patient clinic and at a review visit 3 months later. On each of these occasions an objective assessment of psoriasis severity score was made by the dermatologist. We were able to confirm previous reports of major psychosocial effects of psoriasis on the life-style of many patients. At their first visit 67% (30/45) of patients stated that their life-style was affected by psoriasis, while at review 3 months later this figure was 40% (18/45). Overall 76% (34/45) of patients felt their psoriasis had improved following attendance at the clinic, while 11% (5/45) of patients felt it had deteriorated over the 3-month period. However, all patients stated they found attendance at the out-patient clinic to be of benefit. There was a significant correlation between the psoriasis severity score by the patient and by the dermatologist (P less than 0.001).

Adolescent↗
PubMed1992

Nine years' experience of BELD combination chemotherapy (bleomycin, vindesine, CCNU and DTIC) for metastatic melanoma.

During the 9-year period from 1982 to 1991, 72 patients with melanoma were treated with a 5-day quadruple drug chemotherapy regime (BELD) comprising bleomycin, vindesine (Eldesine), CCNU (Lomustine) and DTIC. Forty-three patients had stage III melanoma, 34 of whom had evaluable disease. Of these 34, six (17.6%) achieved a complete response (CR), eight (23.5%) had a partial response (PR), five (14.7%) had stabilized disease (SD) and 15 (44.1%) had progressive disease (PD). Overall median survival of stage III melanoma patients was 38 weeks. Median survival of responders (CR + PR) was 47 weeks and 21 weeks for non-responders (SD + PD) (P < 0.005). Median follow-up time was 38 weeks. Following these encouraging results, 30 patients with stage II melanoma received BELD chemotherapy as adjuvant therapy after regional node dissection and clearance. Adjuvant BELD chemotherapy did not alter survival in these patients. BELD combination chemotherapy is well-tolerated, the main problems being nausea, vomiting, and leucopenia. We have maintained a combined response rate (CR + PR) of 41.1% for stage III disease. This is comparable with other combination chemotherapy regimes, which have as yet not been superseded by the newer biological therapies.

Adult↗
PubMed1992

The desmoplastic melanocytic naevus: a distinct histological entity.

Fifteen cases of desmoplastic melanocytic naevi are described in 12 female and three male patients, ranging in age from 8 to 83 years. The commonest site for the lesions was the upper limb. The lesions were characterized by a dense sclerotic or desmoplastic appearance of the dermal collagen surrounding a population of predominantly epithelioid naevus cells, some of which had a bizarre but non-malignant cytology. The cause of the stromal change is not established. We suggest that these lesions constitute a discrete entity which should be described in standard textbooks of dermatopathology.

Adult↗
PubMed1989

A comparative study of the relative sensitivity and specificity of radiolabelled monoclonal antibody and computerised tomography in the detection of sites of disease in human malignant melanoma.

A monoclonal antibody raised against the high molecular weight melanoma antigen was labelled with indium-111 and injected intravenously into 25 patients with malignant melanoma. The results obtained from images at 24 and 96 h post i.v. administration of the antibody were compared with results obtained from computerised tomography studies with regard to detection of previously unrecognised sites of metastatic disease and apparent false positive localisation. Detailed study of the patients' clinical condition and detection rates using the two methods suggest that both methods detect approximately 80% of clinically and pathologically confirmed metastases. Of 62 known metastases, the antibody detected 50 (81%), with 17 false positive results. False negatives were most common in the lung. In eight patients the two methods were considered of equal value, in 10 the monoclonal gave a greater amount of clinically relevant information, and in seven the CT was superior. In three patients clinically significant metastatic lesions were detected by the radiolabelled monoclonal and had not been previously recognised either by CT scanning or on clinical grounds. No patients had any adverse reaction to the antibody and in the course of our study the dose of antibody was reduced from 20 mg to 200 micrograms with no apparent loss of sensitivity. In at least two patients uptake of the labelled monoclonal into tumour sites would have been adequate for effective targeted radiotherapy.

Antibodies, Monoclonal↗
PubMed1988

Experience of a public education programme on early detection of cutaneous malignant melanoma.

A public education campaign is described which aimed at encouraging earlier self recognition and thus treatment of cutaneous malignant melanoma. The unique aspect of this campaign was that the changes in the numbers of referrals of patients with melanomas and the changes in the hospital workload associated with this programme were quantified. In the calendar year of the campaign and the following year a statistically significant rise was seen in the percentage of thin melanomas with a good prognosis that were treated and a concomitant significant fall in the proportion of thick lesions with a poor prognosis.

Education, Medical, Continuing↗
PubMed1986

Reasons for poor prognosis in British patients with cutaneous malignant melanoma.

One hundred and twenty five patients presenting in the west of Scotland with primary cutaneous malignant melanoma answered a detailed questionnaire to establish whether there was any evidence of inappropriate delay in receiving surgical treatment for a new or changing pigmented lesion. The survey was carried out because of the relatively high proportion of patients in Scotland with melanoma presenting with primary lesions categorised as "thick, poor prognosis" and the poor five year survival figures as compared with many other countries. Of the 125 patients questioned, only 20 (16%) had received appropriate surgical treatment within three months of becoming aware of a suspicious cutaneous pigmented lesion; 63 (50%) had received surgical treatment three to 12 months after first noticing such a change, and in 42 cases (34%) this interval was over one year. In 102 of 105 patients in whom the interval exceeded three months the patient alone was responsible for the delay; in only three cases was the family doctor partially at fault. No evidence of delay by the hospital service was identified. Because of these findings a public education campaign was launched in the west of Scotland in June 1985 with the aim of improving recognition of early malignant melanoma. In the next six months the proportion of patients in the west of Scotland with primary melanomas categorised as "thin, good prognosis" had risen from 38% to 62%, and the proportion with tumours categorised as "thick, poor prognosis" had fallen from 34% to 15%.

Adult↗
PubMed1986

Proposed alternative terminology and subclassification of so called "dysplastic naevi".

The term "dysplastic" melanocytic naevus has recently been used to describe pigmented naevi with unusual histological and clinical features. There is currently no clear clinical or pathological definition of the term, and this has led to a lack of comparability of material described in reports on these lesions. As a result of careful histological study and a clinicopathological correlation of 100 naevi, we suggest that three distinct groups of histopathological features distinguish so called dysplastic naevi from banal melanocytic naevi. These are architectural atypia, cytological atypia, and a host response. Description of each of these features in routine reports and in published series in place of the loose use of the term "dysplastic" would enable comparisons to be made between series of melanocytic lesions reported from different centres. In the course of this study we observed a considerably increased incidence of naevus type giant cells in the dermal portion of the atypical naevi. These giant cells should not be confused with possibly premalignant cytological atypia.

Humans↗