Showing papers by "Arnon D. Cohen published in 2001"

Calcium channel blockers intake and psoriasis: a case-control study.

Abstract: In vitro evidence suggests that intracellular calcium metabolism influences keratinocyte differentiation. However, only a few reports have described exacerbation of psoriasis or psoriasiform eruptions due to intake of calcium channel blockers. We conducted a case-control study to evaluate the association between exposure to calcium channel blockers and psoriasis. Data were obtained through a retrospective assessment of the files of 150 patients hospitalized for psoriasis or psoriasiform eruptions and 150 matched control patients. Exposure to calcium channel blockers was recorded in case and control patients. It was found that 13/150 patients hospitalized for psoriasis consumed calcium channel blockers. Calcium channel blockers were associated with precipitation of new-onset psoriasis (n = 2), as well as with the exacerbation of psoriasis (n = 11). The calcium channel blockers were as follows: nifedipine (n = 10), felodipine (n = 2) and amlodipine (n = 1). The median latent period between the beginning of intake of calcium channel blockers and precipitation or exacerbation of psoriasis was 28 months (range 4-143 months). A stepwise multivariate logistic regression analysis demonstrated that intake of calcium channel blockers was significantly associated with psoriasis, as compared to the control group (p = 0.018). Our study implies a possible role of calcium channel blockers as precipitating or exacerbating factors in patients with psoriasis.

Acute generalized exanthematous pustulosis mimicking toxic epidermal necrolysis.

Abstract: A 91-year-old patient presented with a nonfebrile, pruritic, widespread eruption that appeared 10 days after starting therapy with cefuroxime tablets, 1000 mg/day, due to stasis dermatitis with secondary infection. The patient was also treated with paracetamol tablets, 500–1000 mg/day, 10 days before the onset of the eruption. Previous diseases included congestive heart disease, hyperglycemia, and ectropion. There was no personal or family history of psoriasis. Additional medications, taken for more than 2 years at the time of the eruption, included indomethacin, captopril, hydrochlorothiazide, isosorbide-5-mononitrate tablets, and a combination drug Laxative®. Examination revealed widespread erythema involving 95% of the total body surface area, with numerous 1–2 mm nonfollicular pustules (Fig. 1). There was no predilection to the body folds. Within 24 h of hospitalization, during intravenous therapy with cefuroxime, the patient's condition worsened and bullae containing clear fluid appeared. Nikolsky's sign was positive on erythematous skin, and eventually skin detachment involved 41% of the total body surface area (Fig. 2). There were no target or target-like lesions and there was no involvement of the mucous membranes. Figure 1. Numerous, 1−2 mm, nonfollicular pustules, with confluence (viewed in the lower left part of the photograph), on erythematous skin Download figure to PowerPoint Figure 2. Widespread skin detachment Download figure to PowerPoint An early biopsy from a pustule revealed subcorneal and intraepidermal spongiform pustules, papillary edema, perivascular mononuclear infiltrate with a few eosinophils in the dermis, and leukocytoclastic vasculitis. A later biopsy showed similar findings with no evidence of full-thickness epidermal necrosis or necrotic keratinocytes. Direct immune fluorescence (DIF) taken from erythematous skin was negative. Laboratory studies showed the following results: sedimentation rate, 80 mm/h; white blood cell count, 26,200/mm3 with 87% polymorphonuclears and 1.8% eosinophils; hemoglobin, 13.0 g/dL; albumin, 2.8 g/dL (normal, 3.5–5.5 g/dL); other blood chemistry tests were normal. Immunologic studies for rheumatoid factor, antinuclear antibodies, antismooth muscle antibodies, antiparietal cell antibodies, antimitochondrial antibodies, C3, and C4 were normal or negative. Serology for venereal disease research laboratory (VDRL) test, Epstein–Barr virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and antistreptolysin titer was negative. Chest X-ray was normal. Blood cultures were negative. Swab cultures taken from the pustules revealed Staphylococcus aureus as well as coagulase-negative Staphylococcus. All systemic drugs, including intravenous cefuroxime, were withdrawn with close monitoring for signs of heart failure or infection. Topical therapy consisted of application of wet dressings. Within 10 days, the eruption resolved with re-epithelialization of the erosions and the appearance of widespread post-pustular desquamation (Fig. 3) Figure 3. Post-pustular desquamation on the trunk Download figure to PowerPoint

Treatment of multiple miliary osteoma cutis of the face with local application of tretinoin (all-trans-retinoic acid): a case report and review of the literature.

Abstract: BACKGROUND: Multiple miliary osteoma cutis of the face represents primary extra-skeletal bone formation that arises within the skin of the face. METHODS: A 60-year-old woman with multiple miliary osteoma cutis of the face was treated by application of 0.05% tretinoin (all- trans -retinoic acid) cream nightly. RESULTS: After 3 months of therapy there were fewer papules and a decrease in size of remaining lesions. In a literature search, it was found that local application of tretinoin was successful and achieved a decrease in the number of papules over the face in all patients with multiple miliary osteoma cutis of the face; however, the length of time to achieve response varied from a few weeks to 6 months. CONCLUSION: It is suggested that local application of tretinoin cream should be considered in the therapy of multiple miliary osteoma cutis of the face, particularly when the lesions are small and superficial.

Clinical and pathological findings in reexcision of incompletely excised basal cell carcinomas.

Abstract: In common practice, patients with incompletely excised basal cell carcinomas (BCCs) are referred to elective reexcision In previous reports, it was observed that tumor cells are found in only 50% of the reexcised specimens The authors performed a retrospective analysis of a large series of patients to evaluate clinical and pathological findings in patients who underwent reexcision of incompletely excised BCCs A total of 1,478 BCCs arising in 1,278 patients were excised by plastic surgeons in a plastic and reconstructive surgery department during a 4-year period In 159 patients (108%), the excision was incomplete according to the pathological report These tumors were defined as an incompletely excised BCCs One hundred of the 159 patients with incompletely excised BCCs (629%) were reoperated Residual tumor cells were found in 28 of 100 patients (28%) within the pathological specimen of the reexcised tissue (defined as positive reexcision, or +veRE) There was no correlation between +veRE and the age or sex of the patient Location of the BCCs in the cheeks, eyelids, or ears was associated with a low percent of +veRE (100%, 133%, and 222% respectively) Pathological factors associated with a low percent of +veRE were dermal inflammatory infiltrate in the pathological specimen (p = 0003) and sun damage pathological changes (p = 003), but there was no correlation with the pathological subtype distribution of the tumors The authors conclude that lack of tumor cells at reexcision of incompletely excised BCCs is associated with location of the tumors in the cheeks, eyelids, and ears, and with pathological findings of dermal inflammatory infiltrates or sun damage changes The roles of inflammatory and solar changes in the destruction of residual carcinoma cells should be investigated further

Cherry angiomas associated with exposure to bromides.

Abstract: Cherry angiomas are the most common vascular proliferation; however, little is known about the pathogenesis and etiology of these lesions. We present two laboratory technicians who were exposed to brominated compounds for prolonged periods and who developed multiple cherry angiomas on the trunk and extremities. We suggest that the association between exposure to bromides and cherry angiomas should be investigated by a controlled study.

Which intercurrent infections are associated with maculopapular cutaneous drug reactions? A case-control study.

Abstract: Background Patients with lymphotrophic viral infections are at increased risk for cutaneous drug reactions (CDRs). However, the association between other intercurrent infections and maculopapular CDRs has not been evaluated by epidemiologic methods. Objective We conducted a case-control study in order to evaluate the exposure to intercurrent infections in patients with maculopapular CDRs. Methods Data were obtained through assessment of files of 53 patients hospitalized for maculopapular CDRs in the Department of Dermatology and 159 control patients. Exposure to intercurrent infections was recorded in patients and controls. Results An intercurrent infectious disease was documented in 31/53 (58.5%) of patients with CDRs, as compared to 12/159 (7.5%) patients in the control group (OR 17.26, 95% CI: 7.24–42.00). Maculopapular CDRs were associated with respiratory tract infections (OR 20.53, 95% CI: 5.20–94.45), and urinary tract infections (OR 20.61, 95% CI: 2.36–465.99), but not with skin infections (OR 3.83, 95% CI: 0.85–17.87) or other infections. Conclusions Our study implies that maculopapular CDRs are associated with respiratory tract infections as well as urinary tract infections. Further study is needed to evaluate the role of intercurrent infections in the pathogenesis of CDRs.

[In vitro interferon-gamma release--a laboratory diagnosis of cutaneous adverse drug reactions].

Abstract: Diagnosis of cutaneous adverse drug reactions is an accepted terminology. Is a challenge. Drug-specific T-cell clones (CD4+ or CD8+), with a Th1- or a Th2-type cytokine-release pattern, may be generated from the peripheral blood in CADRs. In vitro drug-induced cytokine-release suggests a drug-specific immune response, and may implicate the drug as a possible inducer of the skin reaction. We evaluated the diagnostic role of in vitro drug-induced interferon-gamma (IFN-gamma) release from peripheral blood lymphocytes in patients with CADRs. We studied 22 patients with CADRs following intake of 45 drugs (1-4 drugs per patient). Drugs were classified into 3 categories of suspicion. 17 patients who took 39 drugs of the same type (1-4 drugs per patient) without developing adverse reactions, served as controls. In vitro drug-induced release of IFN-a from peripheral blood lymphocytes, following in vitro challenge with the unmodified drugs, was evaluated. The mean IFN-gamma increase following 45 drug tests (60.8 +/- 85.2%) was higher (p < 0.05) than in controls after 39 drug tests (30.1 +/- 27.7%). Significance was greater (p < 0.005) when the mean IFN-gamma increase for the 24 highly suspected drugs (75.1 +/- 93.4%) and that for the controls were compared. This study suggests that the in vitro drug-induced IFN-gamma release test may serve as a diagnostic tool in CADRs.

Gaussian Subtraction (GS) Algorithms for Word Spotting in Continuous Speech

Abstract: In this paper, a novel approach for the design of cohort models for word spotting in continuous speech is presented. This new approach is based on modifying the probability density function of a conventional filler so that regions in the feature space that are related to the keyword will be reduced or removed. By modifying these regions, the filler and keyword models become more orthogonal in the sense that they represent different areas in the feature space, making the filler appropriate to be used as a cohort model. The algorithms, named Gaussian Subtraction (GS) and Gaussian Removal (GR), may be considered discriminative training algorithms.