Biomedical subjects
W D Paterson
Publications and source records attributed to W D Paterson.
Basal cell carcinoma: are early appointments justifiable?
In the U.K., patients with suspected skin tumours are usually referred from a general practitioner to a hospital-based dermatologist for treatment. The urgency of such referrals is currently a topic of political importance. We have studied case record data from 162 patients with basal cell carcinoma (BCC) to establish the relevance of referrals routinely being considered urgent. At presentation, mean tumour size (maximum dimension) was 7. 4 mm (median 10) and mean duration of BCC was 20.5 months (median 12). There was no correlation (all P > 0.05) between tumour size and patient age (r = 0.1325), tumour size and duration (r = 0.4433), or tumour size and interval between referral and hospital consultation (r = 0.0695). If the slow growth rate of the average BCC is assumed to be linear, a reduction in referral interval from the mean value of 10.7 weeks in our patients down to the U.K. government target of 2 weeks would equate to a size difference in BCC of 0.7 mm, which is not therapeutically significant. Individual BCCs with rapid growth or other features of concern may require urgent referral, but evidence from our patients and from other studies is that this is not routinely necessary.
Management and morbidity of cellulitis of the leg.
Ascending cellulitis of the leg is a common emergency. An audit was conducted in two district general hospitals to determine how it is managed and the long-term morbidity, and to formulate a treatment strategy. Case notes were reviewed for 92 patients admitted to hospital under adult specialties. Mean duration of inpatient therapy was 10 days. A likely portal of entry was identified in 51/92 cases, of which the commonest were minor injuries and tinea pedis. Pathogens were rarely identified, group G streptococci being the single most frequent organism. Benzylpenicillin was administered in only 43 cases. Long-term morbidity, identified in 8 of 70 patients with over six months' follow-up, included persistent oedema (6) and leg ulceration (2); an additional 19 patients had either suffered previous episodes or experienced a further episode subsequently. Ascending cellulitis of the leg has substantial short-term and long-term morbidity. Important but often neglected therapeutic suggestions are the inclusion of benzylpenicillin in all cases without a contraindication, assessment and treatment of tinea pedis, use of support hosiery, and serological testing for streptococci to confirm the diagnosis in retrospect. The high frequency of recurrent episodes suggests that longer courses of penicillin, or penicillin prophylaxis, might be useful.
A reticulate vascular abnormality in patients with lymphoedema: observations in eight patients.
We describe eight patients with lymphoedema who had prominent compressible ridges of tissue in a reticulate pattern, situated predominantly on the upper part of the lower leg. In five patients the lymphoedema was primary, two patients had circumferential venous ulceration, and one had marked venous disease with a small ulcer. One patient had a squamous cell carcinoma of the medial thigh and dysplastic keratoses in the distribution of the reticulate ridges. In three of the four cases in whom histological examination of the ridges was performed, the skin at these areas was demonstrated to contain grossly dilated angular vessels in the mid-dermis, many with valves visible. The vessel walls had a single layer of endothelial cells (anti-factor VIII-related antigen positive) and a basement membrane containing type IV collagen. Abnormal elastic tissue in these biopsies was similar to that in erythema ab igne. Indirect lymphography in one case did not demonstrate dilated lymphatic vessels. The body site distribution and clinical pattern of the abnormality appeared to be similar to erythema ab igne but associated with an underlying abnormality of lymphatic rather than blood vasculature. We propose that our cases may represent 'lymphoedema ag igne'.
Cutaneous manifestations of carpal tunnel syndrome.
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Ocular toxicity of antimalarials in dermatology: a survey of current practice.
A questionnaire sent to 325 U.K. dermatologists regarding toxicity of antimalarials had a 70% response rate. Hydroxychloroquine (HCQ) was used by 168 respondents, chloroquine (CQ) by 66, and mepacrine by 89 (only 111 always chose one of these). HCQ was considered to be the most effective by 59%, and to have the least cutaneous side-effects by 66%; mepacrine was considered to have the lowest frequency of ocular side-effects by 50%. Thirty respondents had encountered ocular side-effects, but in most cases these were mild. Maculopathy after short-term therapy was identified as a side-effect which is rarely considered. Ocular side-effects were believed to be due to cumulative dose alone by 31%, to dose/body weight alone by 8%, to duration of treatment alone by 3%, and to combinations of these by 58%. Overall, cumulative dose was considered relevant by 85%, duration of treatment by 52%, and dose/body weight by 41%. Referral for ophthalmology screening was always performed at baseline or after an initial trial of therapy by 56%; 17% never referred patients for baseline screening; 60% routinely requested ophthalmological follow-up. In comparison, 14% of respondents routinely referred patients for baseline ophthalmological screening before PUVA therapy (only 52% of whom routinely referred patients before antimalarial therapy). The most important factor contributing to an individual's current practice was experience in training posts (52%), followed by advice of local ophthalmologists (45%), personal experience (19%), specific publications (16%), and manufacturers' recommendations (14%).(ABSTRACT TRUNCATED AT 250 WORDS)
Blisters, ulceration and autonomic neuropathy in carpal tunnel syndrome.
We describe three patients with trophic ulceration and blistering of the fingertips associated with carpal tunnel syndrome. One of the patients also had non-insulin-dependent diabetes mellitus. Autonomic neuropathy distal to the carpal tunnel was probably present in all subjects at the time of presentation; in the patient with recent symptoms the skin was warm, and sweating was virtually absent, whilst the other two patients described cold skin, consistent with prolonged autonomic neuropathy.
Epidemiology of scabies: the new epidemic.
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Osteochondroma of humerus in focal dermal hypoplasia (Goltz) syndrome.
Focal dermal hypoplasia (Goltz) syndrome was diagnosed in a 26-year-old female subject and her 5-year-old daughter. The mother had been treated surgically for syndactyly in early childhood, and at the age of 12 years had developed a large osteochondroma of the proximal humerus. This is a further bone tumour which should be added to the skeletal manifestations of this syndrome.
Angioma serpiginosum: a simulator of purpura.
We describe two patients with angioma serpiginosum who had both undergone a variety of haematological tests for investigation of purpura, but in whom careful examination of the skin demonstrated abnormal blood vessels rather than extravasated blood. Recognition of vascular disorders which simulate purpura may avoid unnecessary investigations.
Acquired C1-inhibitor deficiency preceding malignant lymphoma by 7 years.
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Pruritus and nocturnal wakenings.
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Lymphomatoid papulosis/pityriasis lichenoides in two children.
Two children developed lymphomatoid papulosis/pityriasis lichenoides at ages 3 and 6 years. Follow-up continued for 13 years in the former patient and for 6 years in the latter. Both children now have continuing low-grade disease activity requiring in the one case topical corticosteroid therapy and in the other low-dose systemic steroid therapy. These children are reported to emphasize to pediatricians, pediatric pathologists, and hematologists that pseudolymphomatous conditions can exist in young children and do not require potent cytotoxic therapy. In both of our patients, the initial diagnosis was thought to be an aggressive lymphoma.
Pseudallescheriasis in northern Britain.
Five cases of Pseudallescheria boydii infection are reported from the northern part of the United Kingdom. None of the patients had travelled abroad. Three cases of otitis in which P. boydii was associated with bacterial infections were diagnosed within a 6-month period. A lady who had diabetes mellitus presented with a pulmonary fungus ball in a pre-existent cavity caused by a previous bacterial infection. After minor trauma at the site of an old skin graft, a farmer's wife developed an ulcer on the dorsum of the right ankle. Precipitating antibodies were demonstrated except in two of the cases of ear infection. The management of the individual cases is discussed.
How important are the dermatophytes? A clinical and laboratory investigation.
Dermatophyte infections were established in 6.9% of 640 unselected dermatology outpatients attending two district general hospitals in Cumbria over a six-month period. A clinical diagnosis of ringworm was confirmed in the laboratory in 43.1% of hospital and in 21.8% of a smaller series of general practice patients. No result of similar surveys have been published before., Even in a major stock-rearing area such as this, domestic pets appear to be a more important source of infection than the farm animal.
Relationships between selected strains of typical and atypical Aeromonas salmonicida, Aeromonas hydrophila, and Haemophilus piscium.
Serological analyses of typical and atypical Aeromonas salmonicida divided the representative strains into two distinguishable groups based on their antigenic composition. However, the serological groupings do not coincide with divisions constructed on the basis of physiological reactions. All of the A. salmonicida strains and the two A. hydrophila strains examined share at least one antigen and are sensitive to A. salmonicida bacteriophage 40 RR2.8t. These data reinforce the reasons for placing these two species in the genus Aeromonas. Haemophilus piscium, the causative agent of ulcer disease, was serologically indistinguishable from A. salmonicida and sensitive to A. salmonicida bacteriophages. This information, in addition to published H. piscium DNA studies, suggests this organism is actually an atypical A. salmonicida; more H. piscium isolates should be characterized to confirm this identification.
Rate and duration of phagocytic increase in lobsters induced by Pseudomonas perolens endotoxin.
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Effects of trimeprazine and trimipramine on nocturnal scratching in patients with atopic eczema.
Twelve men with severe and long-standing atopic eczema were admitted to a double-blind trial to establish the effects of trimeprazine tartrate, trimipramine maleate, and placebo on nocturnal scratching. Neither of the drugs altered the likelihood of a scratching bout beginning in wakefulness or in any stage of sleep. However, both drugs, especially trimipramine, made sleep less broken, and the reduced time spent in stage 1 of sleep accounted for a modest reduction in the overall amount of scratching during the night.