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  • 1
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: There is some controversy about the prevalence of onychomycosis in patients with psoriasis compared to non-psoriatics. We therefore measured the prevalence of toenail onychomycosis in psoriatics and non-psoriatics attending dermatologists'offices. None of the patients had a referring diagnosis of onychomycosis. The prevalence of pedal onychomycosis in psoriatics (n = 561) was 13%. The odds of patients with psoriasis having onychomycosis was 56% greater than non- psoriatics of the same age and sex (P= 0·02). In the psoriatics, when the toenails were clinically abnormal, the prevalence of onychomycosis was 27%. The odds of developing onychomycosis increased with age (P 〈 0·0001) and the odds of men developing onychomycosis was 2·5 times that of women (P= 0·0001). The duration of psoriasis did not significantly affect the odds of developing onychomycosis. The fungal organisms recovered from psoriasis subjects with onychomycosis were similar to those in the normal population with onychomycosis (P = 0·58).
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2230
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: An unusual form of essential acquired cold urticaria occurring in a 30-year-old woman is reported. Exposure of the skin to cold produced immediate wealing and angio-oedema with subsequent deep bruising, and severe systemic symptoms.Light microscopic, ultrastructural and immunofluorescence studies of serial biopsies from the cold-evoked skin lesions established a time course for the histological events occurring during the evolution of the inflammation. The appearance of complement (C3) in dermal blood vessels preceded the deposition of fibrin and immunoglobulin and obvious mast-cell degranulation. These secondary changes accompanied a perivascular infiltrate of mixed inflammatory cells and lysis of both neutrophil and eosinophil leukocytes. Later, disruption of vascular endothclium was notable.Elevated histamine levels in venous blood draining a cold-challenged limb indicated that histamine was released, possibly from skin mast cells, during the development of the urticaria.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Two patients with urticaria evoked at the site of contact of skin with water have been studied. Protection of the skin from contact with water by prior application of petrolatum ointment prevented wealing, but removal of the stratum corneum enhanced wealing.Organic solvents did not themselves evoke wealing, but they enhanced the reaction to subsequent challenge by water.That the release of acetylcholine is an essential step in the pharmacogenesis of wealing in aquagenic urticaria is indicated by the suppressive effect of locally-applied scopolamine on water–evoked wealing.Aquagenic urticaria is also associated with elevated blood histamine levels and degranulation of mast cells in the water–challenged skin.The relationship of acetylcholine and histamine to each other and to contact of water with the skin remains uncertain.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The treatment of venous ulcers must start with compression and if the ankle brachial index is greater than 0.8 high compression bandages can be applied. Despite edema control, there are a number of venous ulcers that do not heal at the expected rate. Patients with venous ulcers of greater than 4 weeks duration were treated with a prolonged release absorptive nanocrystalline silver dressing (Acticoat 7) under the 4 layer bandage, Profore for 12 weeks, or until healing. Biopsies were obtained from the ulcer base at week 0 for histology and bacterial burden. Duplicate biopsies for quantitative bacteriology were performed with one submitted whole and the second bisected into superficial and deep components. The paired biopsies were then repeated after a median of 6.5 weeks (range 2 to 12 weeks). The histological specimens were examined by the histopathologist (SR). Inflammatory infiltrates were identified in the superficial, middle and deep segments of the biopsies. Acute infiltrates were identified through the concentration of neutrophils and chronic infiltrates by the presence of lymphocytes. Each biopsy and each segment was graded for infiltrates on a four point semi quantitative score. A total of 15 patients (9 male, and 6 female) were enrolled into the study. The median age was 63 years (range 30–83 years). The median duration of current ulceration was 17.3 weeks (range 4 weeks to 11 years) and the median ulcer area was 4.8 cm2(range 1.8–43.9 cm2). The median exposure to Acticoat 7 was 82 days (range 8–86 days).There were 12 sets of paired biopsies that were analyzed. There was a statistically significant reduction (p = 0.0114) in the log10(total bacterial count) between the baseline and final biopsies (median 4.48 and 3.00, respectively). Four patients healed, 8 patients continued to the end of the 12-week study period and three patients were discontinued early. For all patients, the median percentage reduction in ulcer area was 94.4% and the median final ulcer area was 0.4 cm2. Analysis of the histology and bacteriology data demonstrated that the presence of a high neutrophilic infiltrate in skin biopsies was associated with high bacterial counts (superficial compartment of the quantitative biopsies) at week 4 and delayed healing (p = 0.037). In the week 0 biopsy, increased lymphocytic infiltrates within the superficial and middle segments were associated with accelerated healing in the first 4 weeks (p = 0.26 and 0.09). The nanocrystalline silver dressing has demonstrated an anti-bacterial and permissive but selective anti-inflammatory action allowing lymphocytic infiltrates to increase associated with an accelerated reduction in ulcer size.
    Type of Medium: Electronic Resource
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