Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
1.
J Dermatolog Treat ; 32(2): 132-136, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31180795

RESUMO

BACKGROUND/OBJECTIVE: Mirtazapine has traditionally been used for the treatment of major depressive disorder, with an added benefit in patients who have comorbid insomnia or anxiety. Recent studies describe its usefulness in treating refractory pruritus of various causes as well. Our goal is to better define the use of mirtazapine in the treatment of refractory pruritus. METHOD: Through a thorough literature review of PubMed, we identified all reports of the use of mirtazapine for pruritus. RESULTS: Upon examination of 8 supporting articles, we found mirtazapine has quality evidence for the treatment of intra-thecal morphine-induced pruritus. Mirtazapine may also be effective in treating pruritus related to various other conditions, including psoriasis, atopic dermatitis, cutaneous malignancies (primary or metastatic), hematologic malignancies (lymphomas and leukemias), liver failure, renal failure, cholestasis, as well as pruritus of unknown origin. CONCLUSIONS: Mirtazapine plays a role in treatment for intra-thecel morphine-induced pruritis yet high-quality trials are needed to confirm its efficacy in other dermatologic conditions.


Assuntos
Antidepressivos/uso terapêutico , Mirtazapina/uso terapêutico , Prurido/tratamento farmacológico , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Ensaios Clínicos como Assunto , Humanos , Prurido/etiologia , Prurido/patologia , Receptores Histamínicos H1/química , Receptores Histamínicos H1/metabolismo , Receptores de Serotonina/química , Receptores de Serotonina/metabolismo
2.
Neurooncol Adv ; 2(Suppl 1): i107-i116, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32642736

RESUMO

Neurofibromatosis type 1 (NF1) is a life-long neurocutaneous disorder characterized by a predisposition to tumor development, including cutaneous neurofibroma (cNF), the hallmark of the disease. cNF is a histologically benign, multicellular tumor formed in virtually most individuals with NF1. It is considered the most burdensome feature of the disorder due to their physical discomfort, cosmetically disfiguring appearance, and psychosocial burden. Management of cNF remains a challenge in the medical field. Effective medicinal treatment for cNF does not exist at this time. Trials aimed at targeting individual components of the neoplasm such as mast cells with Ketotifen have not shown much success. Physical removal or destruction has been the mainstay of therapy. Surgical removal gives excellent cosmetic results, but risk in general anesthesia may require trained specialists. Destructive laser such as CO2 laser is effective in treating hundreds of tumors at one time but has high risk of scarring hypopigmentation or hyperpigmentation that alter cosmetic outcomes. A robust, low-risk surgical technique has been developed, which may be performed in clinic using traditional biopsy tools that may be more accessible to NF1 patients worldwide than contemporary techniques including Er:YAG or Nd:YAG laser. In this review, specific recommendations for management of cNFs are made based on symptoms, clinical expertise, and available resources. Additionally, antiproliferative agents aimed at stimulating cellular quiescence are explored.

3.
Oncotarget ; 10(57): 5958-5969, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31666927

RESUMO

Anal squamous cell carcinoma (ASCC) is a rare, potentially fatal malignancy primarily caused by high-risk human papillomaviruses (HPV). The prognostic implication of programmed death-ligand 1 (PD-L1) expression remains controversial, and glucose transporter 1 (GLUT1) expression has never been examined in ASCC. Covalently closed circular RNAs have recently been shown to be widespread in cancers and are proposed to be biomarkers. We discovered HPV16 expresses a circular E7 RNA (circE7) which has not been assessed as a potential biomarker. A retrospective, translational case series at UT Southwestern was conducted to analyze PD-L1, GLUT1, HPV-ISH, and HPV circE7 in relation to the clinical features and overall survival of patients with ASCC. Twenty-two (22) subjects were included in the study. Improved overall survival was predicted by basaloid histology ( p = 0.013), PD-L1 expression ( p = 0.08), and HPV-ISH positivity ( p & 0.001), but not GLUT1 expression. High levels of circE7 by quantitative RT-PCR predicted improved overall survival in ASCC ( p = 0.023) and analysis of The Cancer Genome Atlas sequencing from HPV-positive head and neck cancer and cervical cancer suggested high circE7 marked improved survival in 875 subjects ( p = 0.074). While our study suggests that circE7 levels correlate with improved survival in ASCC, larger, prospective studies are necessary to confirm the potential role of circE7 as a biomarker.

4.
Pediatr Dermatol ; 36(5): 723-724, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31190328

RESUMO

A 6-year-old girl with a history of chronic immunosuppression following small bowel and colon transplantation for tufting enteropathy presented with a diffuse, facial-predominant eruption composed of pink-to-skin-colored papules with central white dystrophic spicules. Histology from a punch biopsy and polymerase chain reaction (PCR) from plucked spicules confirmed a diagnosis of trichodysplasia spinulosa (TS). Additional molecular studies identified several strains of the trichodysplasia spinulosa-associated polyomavirus infecting multiple tissues of the patient, confirming the systemic nature of trichodysplasia spinulosa infections.


Assuntos
Doenças do Cabelo/etiologia , Infecções por Polyomavirus/patologia , Polyomavirus , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Infecções Tumorais por Vírus/patologia , Criança , Feminino , Doenças do Cabelo/patologia , Humanos
5.
Pediatr Dermatol ; 36(5): 623-627, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31197875

RESUMO

BACKGROUND/OBJECTIVES: Anogenital verrucae (AV) are benign, human papillomavirus (HPV)-induced tumors of the anogenital skin and mucosa. Medical therapy for AV in preadolescents has not been well studied. We explore the efficacy and safety profile of sinecatechins 15% ointment and imiquimod 5% cream in the treatment of AV, alone and in combination therapy with other commonly used medications. METHODS: A single-institution, retrospective review of children under 12 years of age with AV treated with imiquimod 5% cream and sinecatechins 15% ointment was performed. Demographic data, side effects, and outcomes of therapy were recorded for each patient, and overall efficacy was determined. RESULTS: A total of 37 patients met inclusion criteria. Responses were seen in 8 out of 9 patients treated with sinecatechins 15% ointment (5 full, 3 partial, and 1 no response) and 9 out of 17 patients treated with imiquimod 5% cream (4 full, 5 partial, and 8 no response). Combination therapy with one or more of the following treatments (podophyllin, cimetidine, candida antigen injection, and HPV vaccine) were evaluated, but no combination was objectively superior to the others. No significant difference was found in overall efficacy between sinecatechins and imiquimod. Side effects were mild and limited to irritation and erythema. CONCLUSIONS: Both imiquimod 5% cream and sinecatechins 15% ointment are moderately effective in the treatment of AV in preadolescent children, with a trend toward greater effectiveness of sinecatechins. Combination therapy with other treatments did not significantly increase the effectiveness of topical therapies. Each modality has a tolerable side effect profile with a low risk of serious complications.


Assuntos
Antineoplásicos/uso terapêutico , Antioxidantes/uso terapêutico , Catequina/uso terapêutico , Condiloma Acuminado/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Imiquimode/uso terapêutico , Administração Tópica , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
6.
JCI Insight ; 52019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31038470

RESUMO

BACKGROUND: Cutaneous neurofibromas (cNF) are physically disfiguring, painful, and cause extensive psychologic harm in patients with neurofibromatosis type 1 (NF1). There is currently no effective medical treatment and surgical procedures are inaccessible to most NF1 patients globally. OBJECTIVE: While research is underway to find an effective medical treatment for cNF, there is an urgent need to develop surgical approach that is accessible to all NF1 patients in the world with the skill set and equipment found in most general medical office settings. Here, we present a robust surgical approach to remove cNF that does not require sterile surgical field, utilizes accessible clinical equipment, and can be performed by any health care providers including family practitioners, and physician assistants. METHODS: In a prospective case-series, patients with NF1 underwent this surgical procedure which removes multiple cutaneous neurofibromas. The Dermatology Life Quality Index was given to subjects before and after the procedure as surrogate for patient satisfaction. RESULTS: 83 tumors were removed throughout the body from twelve individuals. Examination at follow-up visits revealed well-healed scars without infection or adverse events including aberrant scarring. Patient satisfaction with the procedure was high with significant improvements in symptoms, daily activities, leisure, personal relationships, and treatment experience (P = 0.00062). CONCLUSION: This study demonstrates a robust surgical approach to management cutaneous neurofibromas which can be accessed world-wide to individuals with NF1 and performed by a wide-variety of medical specialists with high clinical efficacy and patient satisfaction.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Neurofibroma/cirurgia , Neurofibromatose 1/cirurgia , Satisfação do Paciente , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Cicatriz , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibroma/diagnóstico por imagem , Neurofibroma/patologia , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/patologia , Estudos Prospectivos , Qualidade de Vida , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Adulto Jovem
8.
Otolaryngol Head Neck Surg ; 160(1): 150-157, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30149781

RESUMO

OBJECTIVES: To evaluate demographic, clinical, and polysomnographic features of children with Down syndrome suspected of having obstructive sleep apnea. To identify factors that predict severe obstructive sleep apnea among children with Down syndrome. STUDY DESIGN: Case series with chart review. SETTING: Children's Medical Center Dallas / University of Texas Southwestern Medical Center. SUBJECT AND METHODS: Demographic, clinical, and polysomnographic data were collected for children with Down syndrome aged 2 to 18 years. Simple and multivariable regression models were used to study predictors of severe obstructive sleep apnea (apnea-hypopnea index ≥10). P≤ .05 was considered significant. RESULTS: A total of 106 children with Down syndrome were included, with 89 (84%) <12 years old, 56 (53%) male, 72 (68%) Hispanic, 15 (14%) African American, and 14 (13%) Caucasian. Ninety percent of children had ≥1 medical comorbidities; 95 (90%) patients had obstructive sleep apnea; and 46 (44%) had severe obstructive sleep apnea. The mean SaO2 nadir was lower among obese than nonobese children (80% vs 85%, P = .02). Obese versus nonobese patients had a higher prevalence of severe obstructive sleep apnea (56% vs 35%, P = .03). Severe OSA was associated with heavier weight (odds ratio = 1.0, 95% CI: 1.0-1.1, P = .002) and age ≥12 years (odds ratio = 1.2, 95% CI: 0.2-2.5, P = .02). The multivariable model showed that severe obstructive sleep apnea was associated only with weight (odds ratio = 1.1, 95% CI: 1.0-1.1, P = .02). CONCLUSION: Obese children with DS are at a high risk for severe OSA, with weight as the sole risk factor. The results of this study show the importance of monitoring the weight of children with DS and counseling parents of children with DS about weight loss.


Assuntos
Síndrome de Down/epidemiologia , Obesidade Infantil/epidemiologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Centros Médicos Acadêmicos , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Comorbidade , Bases de Dados Factuais , Síndrome de Down/diagnóstico , Feminino , Humanos , Masculino , Análise Multivariada , Obesidade Infantil/diagnóstico , Polissonografia/métodos , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Distribuição por Sexo , Texas
9.
J Invest Dermatol ; 139(2): 285-292, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30470393

RESUMO

Human polyomaviruses are double-stand DNA viruses with a conserved genomic structure, yet they present with diverse tissue tropisms and disease presentations. Merkel cell polyomavirus, trichodysplasia spinulosa polyomavirus, human polyomavirus 6 and 7, and Malawi polyomavirus are shed from the skin, and Merkel cell polyomavirus, trichodysplasia spinulosa polyomavirus, human polyomavirus 6 and 7 have been linked to specific skin diseases. We present an update on the genomic and clinical features of these cutaneous polyomaviruses.


Assuntos
Infecções por Polyomavirus/diagnóstico , Polyomavirus/genética , Dermatopatias Virais/diagnóstico , Antígenos Virais/genética , Genoma Viral/genética , Humanos , Polyomavirus/imunologia , Polyomavirus/isolamento & purificação , Infecções por Polyomavirus/imunologia , Infecções por Polyomavirus/virologia , Pele/imunologia , Pele/patologia , Pele/virologia , Dermatopatias Virais/imunologia , Dermatopatias Virais/virologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA