Subject(s)
Academic Medical Centers/economics , Dermatology/economics , Hospital Costs/trends , Reimbursement Mechanisms/trends , Telemedicine/economics , Academic Medical Centers/organization & administration , Dermatology/organization & administration , Humans , North Carolina , Telemedicine/organization & administrationABSTRACT
OBJECTIVE: To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions. DATA SOURCES: Searches of MEDLINE (1966-March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. STUDY SELECTION AND DATA EXTRACTION: Data were obtained primarily from randomized placebo-controlled trials upon which key recommendations are based. DATA SYNTHESIS: Antibiotics are often prescribed for months or even years for treatment of chronic inflammatory conditions such as acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. Randomized controlled trials have shown that azithromycin is useful in the management of cystic fibrosis and the tetracyclines are beneficial in the management of rheumatoid arthritis, acne, blepharitis, and periodontitis. Several large, randomized controlled trials have failed to show any benefit of macrolides in the secondary prevention of cardiovascular disease. No randomized placebo-controlled clinical trials have been performed to assess the efficacy of macrolides or tetracyclines in patients with rosacea. CONCLUSIONS: The use of tetracyclines and macrolides for rosacea is based primarily on anecdotal reports or open-label trials. Limited clinical trials support the use of tetracyclines or macrolides in acne, blepharitis, periodontitis, rheumatoid arthritis, and cystic fibrosis. Trials to date do not support the use of antibiotics for secondary prevention of cardiovascular disease.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Inflammation/drug therapy , Macrolides/therapeutic use , Tetracyclines/therapeutic use , Acne Vulgaris/drug therapy , Arthritis, Rheumatoid/drug therapy , Blepharitis/drug therapy , Cardiovascular Diseases/drug therapy , Chronic Disease , Cystic Fibrosis/drug therapy , Humans , Periodontitis/drug therapy , Rosacea/drug therapyABSTRACT
BACKGROUND: A comparison of diseased areas of skin with adjacent normal skin is often useful in making a diagnosis. Fusiform incisional biopsies have been suggested as a means to this end. OBJECTIVE: To describe a more effective alternative method for obtaining incisional biopsies. METHODS: Text and photographs are used to demonstrate the technique and effectiveness of what we call the "TramTrak" biopsy. RESULTS: This technique provides superior tissue samples with acceptable cosmetic results. CONCLUSION: The TramTrak biopsy has proven to be a versatile tool and a significant improvement over fusiform incisional biopsies.
Subject(s)
Biopsy/methods , Skin Diseases/pathology , Dermatologic Surgical Procedures , Humans , Skin Diseases/surgery , Treatment OutcomeABSTRACT
A phase 1 smallpox vaccine trial involving 350 adult volunteers was conducted. Of these subjects, 250 were naive to vaccinia virus vaccine (i.e., "vaccinia naive"). Volunteers received a new cell-cultured smallpox vaccine or a live vaccinia virus vaccine. Nine self-limiting rashes (3.6%) were observed in the vaccinia-naive group. None of the vaccinia-experienced patients had a rash. Rashes appeared 6-19 days after vaccination and had 5 different clinical presentations. Five volunteers had urticarial rashes that resolved within 4-15 days, 1 had an exanthem that lasted 20 days, and 1 each presented with folliculitis, contact dermatitis, and erythematous papules found only on the hands and fingers. Volunteers reported pruritus, tingling, and occasional headaches. Relief was obtained with antihistamine and acetaminophen therapy. No volunteer experienced fever or significant discomfort.
