Phototoxicity from systemic sodium fluorescein.

PURPOSE: To confirm the occurrence of phototoxicity due to systemic fluorescein in a dose consistent with retinal angiographic testing and to approximate the prevalence of this reaction in a small group of volunteers. METHODS: Fourteen volunteers underwent a controlled challenge test by applying a topical sunscreen and exposing skin areas to direct sunlight before and after fluorescein administration. RESULTS: Two subjects experienced marked cutaneous blanching erythema, mild vesiculation, and pain in sun-exposed areas within 1 hour of exposure. The reaction faded over a period of days without tanning. CONCLUSIONS: Consistent with its in vitro properties as a photodynamic dye, fluorescein may rarely act as a phototoxic agent in humans at doses employed for fluorescein retinal angiography. It is unclear why this reaction has not been reported more frequently, given the large number of patients undergoing this ophthalmic procedure annually.

The Muir-Torre syndrome in a black patient with AIDS: histopathology and molecular genetic studies.

In 1981, a black man had adenocarcinoma of the colon. In 1986, he had a sebaceous adenoma and the diagnosis of the Muir-Torre syndrome was established. The patient was found to be HIV sero-positive in 1986, and 8 years later fulfilled the CDC criteria for AIDS. During 1989 to 1993 the CD4 count was > 200 cells/ml and the patient had 2 sebaceous tumors, 1 basal cell carcinoma and 1 keratoacanthoma. In 1994 to 1996, the CD4 count was < 200 cells/ml and the patient developed 18 sebaceous tumors and a poorly differentiated adenocarcinoma of the finger which metastasized to axillary lymph nodes. Microsatellite analysis of tumor DNA from a sebaceous adenoma and adenocarcinoma of the finger revealed widespread microsatellite instability. The interaction of AIDS with the behavior of the tumors in the Muir-Torre syndrome has not previously been reported. Although our patient had an increase in the number of new sebaceous tumors at the same time he experienced deterioration of the immune system, he is doing well 15 years after resection of adenocarcinoma of the colon and 16 months after metastatic poorly differentiated adenocarcinoma of the skin. This follows the previously observed tendency for cancers of the Muir-Torre syndrome, especially those displaying widespread microsatellite instability, to be less lethal than their histologically similar counterparts in people without Muir-Torre syndrome.

Monitoring for adverse effects from systemic drugs used in dermatology.

Systemic drugs with an associated element of risk are essential in managing many important dermatoses. This review identifies eight major drugs or drug groups used in dermatology that require systematic monitoring for adverse effects. The complete monitoring process is emphasized, including significant patient involvement in reporting key signs or symptoms that allow early diagnosis of many of these adverse effects. The concepts of "risk-risk" assessment and "critical toxicities" are defined, emphasizing their important role in maximizing drug benefits and safety. Drug-related risk factors, disease-specific risk factors, and patient characteristics or habits that increase the risks from systemic drugs are identified. Basic principles of monitoring for adverse effects, specific clinical features of the most important adverse effects, along with detailed monitoring guidelines for methotrexate, retinoids, dapsone, corticosteroids, and cyclosporine are presented.

A survey of resident perceptions of effective teaching behaviors.

Family practice has shown increasing interest in clarifying what constitutes effective teaching skills. This investigation enlists the support of family practice residents to further clarify which teaching behaviors and skills most significantly contribute to their medical education. Family practice residents in all 24 programs in Ohio were surveyed to determine their perceptions of the effectiveness of 38 separate clinical teaching behaviors. A rank order listing of these behaviors is presented to aid in organized faculty development programs, as well as to provide guidelines individual faculty can follow to improve family practice resident education. Factor analysis of the residents' responses indicate that clinical competence, providing constructive feedback to residents, and demonstrating a positive attitude toward teaching residents are perceived as necessary attributes of the most effective clinical teachers.