Toxic epidermal necrolysis; 15 years'' experience in a Dutch burns centre

BACKGROUND: Toxic epidermal necrolysis (TEN) is a severe and potentially fatal drug reaction characterized by an extensive skin rash with blisters and exfoliation, frequently accompanied by mucositis. The wounds caused by TEN are similar to second-degree burns and severe cases may involve large areas of skin loss. OBJECTIVES: Analysis of our results in patients with TEN and evaluation of the variety of therapeutic interventions that has been studied and suggested in TEN. PATIENTS/METHODS: Retrospective analysis of 19 consecutive patients with TEN treated in our burns centre between 1989 and 2004. RESULTS: Immediate withdrawal of any potentially fatal drug, maximum supportive care, and a restricted and tailored antibiotic, medical and surgical treatment regimen confined mortality to 21%, whereas prognosis scores like APACHE II and SCORTEN predicted mortality of 22 and 30%, respectively. A positive contribution of selective digestive decontamination is suggested but has yet to be established. CONCLUSIONS: Because of a potentially fatal outcome, fast referral of a patient suspected of TEN to a specialized centre (mostly a burns unit or specialized dermatology centre) for expert wound management and tailored comprehensive care is strongly advised and contributes to survival.     

EMPACT syndrome

Background: Seizure prophylaxis with phenytoin is a common measure in oncologic patients with brain metastases. In these patients, generalized severe adverse drug reactions such as erythema multiforme (EEM) may occur. However, in a subgroup of patients with brain radiation therapy, EEM‐like lesions develop particularly in the radiation field. Most recently, the acronym EMPACT ( E rythema M ultiforme associated with P henytoin A nd C ranial radiation T herapy) was proposed to specifically describe this syndrome. Patient/Method: Here, we report on EMPACT syndrome in a 46‐year‐old woman. Therapeutic measures included seizure prophylaxis with phenytoin and total brain radiation therapy of brain metastases from bronchial carcinoma. Three weeks after introduction of phenytoin, the patient presented with EEM‐like skin lesions restricted to the original radiation field and facial mucocutaneous involvement. After a few days, the rash spread to the upper part of the body. She was also in poor general condition. Results: The immediate cessation of phenytoin therapy, combined with administration of systemic corticosteroids and high dose immunoglobulins along with intensive local treatment and pain medications, resulted in complete resolution of the skin eruption. Patch testing to phenytoin was positive after 72 hours. Conclusion: EMPACT should be classified as an specific entity among the EEM‐like drug reactions as it only appears after radiotherapy and seizure prophylaxis with the anticonvulsant phenytoin. We propose including specific type IV‐sensitization to phenytoin into the definition of EMPACT.     

Epidemiological considerations following long-term surveillance of invasive group A streptococcal disease in The Netherlands, 1992–2003

A nationwide laboratory-based surveillance system for invasive group A streptococcal (GAS) infections was conducted in The Netherlands from March 1992 until December 2003. Until 1996, all isolates submitted were evaluated clinically and demographically. During this period there was a transition from passive to active surveillance for some of the participating laboratories, corresponding to a national coverage of 50%. During active surveillance, participating laboratories submitted twice as many isolates from invasive GAS disease, whereas the relative submission of isolates representing very severe manifestations (toxic shock-like syndrome, fatality) did not increase. From 1997 onwards, invasiveness was defined solely on the basis of source of isolation (without clinical evaluation). During the period of microbiological and clinical evaluation, microbiological evaluation alone was found to be specific (> 99%), but had limited sensitivity (66%). Estimation of the true rate of invasive GAS disease should be based on an active surveillance system with inclusion of both microbiological and clinical data.     

Atypical Allergic Colitis in Preterm Infants

ABSTRACT. Two atypical cases of colitis due to cow's milk protein intolerance (CMPI) are reported, affecting preterm infants. One developed a toxic dilatation of the colon and responded well to a casein hydrolysate based feed. The second presented insidiously and failed to tolerate a casein hydrolysate, but responded well to a chicken-based modular feed.     

芪丹煎剂有效成分提取方法优选研究

目的:研究芪丹煎剂有效成分超声法提取的最适条件.方法:利用正交试验设计,对水量、提取时间和提取次数进行分析,找出最适条件.按最适条件重复3次,考察重复性.结果:水量为14倍、提取时间为30min,提取次数为3次时有效成分的总含量最大,3次平行试验有效成分总含量RSD为0.86%.结论:超声法提取的最佳条件为:水量14倍、提取时间30min,提取次数3次.本方法重复性较好.     

氧化胆固醇对动脉毒性作用的研究

将Wistar大鼠随机分成氧化胆固醇组(Och)、纯胆固醇组(Pch)和对照组,分别用氧化胆固醇混合物(250mg/kg bw/d)、纯胆固醇(250mg/kg bw/d)以及悬浮固醇用的明胶液体给大鼠灌胃,连续二天。于第二次灌胃后18小时,从大鼠尾静脉注射伊文思兰溶液,并于注射后2小时处死;取出主动脉用荧光显微分光光度术测定主动脉内膜的通透性。此外,另一部分动物在第二次灌胃后24小时处死,取出主动脉作扫描电镜的内膜观察。结果表明,Och大鼠主动脉内膜的通透性显著高于Pch组与对照组大鼠(P<0.01),而Pch组大鼠主动脉内膜的通透性和对照组无显著差异(P>0.05)。     

"Chronic painter''s syndrome". A reanalysis of psychological test data in a group of diagnosed cases, based on comparisons with matched controls

Twenty solvent-exposed workers, most of them painters, had been diagnosed as cases of toxic encephalopathy in 1978/79. Two years later they were re-examined with an extensive battery of neuropsychological tests. Their performance was unchanged on retesting. We have now compared their test results with those of non-exposed control subjects. Previous impressions of significant intellectual impairment in the solvent-exposed patients could not be confirmed when the influence of age, education, and intelligence was taken into consideration. The present group with presumed toxic encephalopathy is assumed to be representative of other patients who were similarly diagnosed in our department. The presently reanalyzed cases had been diagnosed as brain damaged and reported as such in the literature. Thus, they may have contributed to the formation of the concept of the "chronic painters' syndrome" with dementia.     

Production of tumour necrosis factors by human T cells stimulated by a superantigen,toxic shock syndrome toxin-1

The capacity of human T cell subsets, CD4⁺ or CD8⁺ T cells, to produce tumour necrosis factors (TNF-α and TNF-β) upon stimulation with toxic shock syndrome toxin-l (TSST-I) and the requirement for MHC ctass II molecules on accessory cells (AC) in the response were investigated. The capacity of CD4⁺ T cells was much higher than that of CD8⁺ T cells in TSST-1-induced production of TNF-α and TNF-β. The expression of MHC class II molecules on AC was required in the response.     

Effect of sex and the phase of the estrous cycle on intensity of injury and repair processes in the liver of rats with acute carbon tetrachloride poisoning

The pattern of injury and repair in the liver of Wistar rats depending on sex, the phase of the estrous cycle, and also under the conditions of deficiency of female sex hormones and after injection of -estradiol into ovariectomized rats was studied by morphometric, histo chemical, and electron-microscopic methods. Structural disturbances caused by CCl₄ were found to be increased and reparative reactions inhibited in the liver of females both during the period of a natural increase in the blood estrogen concentration and under the influence of exogenous estradiol, and ovariectomy also had a protective effect. In males, structural changes in the liver were more marked than in females with a low blood estrogen level and differend only a little from those in females during the period of increased secretion of sex steroids.Central Research Laboratory, Novosibirsk Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. P. Kaznacheev.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 85, No. 4, pp. 460–464, April, 1978.