Survival after a second episode of toxic epidermal necrolysis

Toxic epidermal necrolysis resulting from severe hypersensitivity to medication has a reported mortality of up to 66%. A patient surviving two episodes with more than a 50% skin loss is unprecedented in the medical literature. Mortality has been associated with many factors, including delayed reepithelialization, persistent skin slough, coagulopathy, severe hypoproteinemia, and sepsis. It may be possible to decrease morbidity and mortality by preventing the shearing of epidermis, thereby limiting the denuded areas. This case report describes the successful management of our patient's second episode of toxic epidermal necrolysis. The treatment of this patient in our specialized burn center consisted of careful fluid and electrolyte management, nutritional support, standard topical antimicrobials, and new modalities of local wound management.     

Regional anesthesia for hand surgery

Several regional anesthetic techniques for hand and wrist surgery are mentioned. Of these techniques, the axillarybrachial plexus block offers several advantages, such as ease of administration, prolongation of analgesia, and very few potential complications. Three conditions must be met to provide effective regional anesthesia: (1) patient instruction, (2) a surgeon comfortable with the technique, and (3) a prepared anesthesiologist. The axillary brachial plexus block is performed aseptically in a manner that promotes proximal spread of local anesthetic, giving the opportunity to block the musculocutaneous nerve before its exit from the sheath. In our institution, we favor 1.5% mepivacaine versus 0.5 bupivacaine because of its inherent safety factor. However, all local anesthetics have the potential for systemic toxicity with either inadvertent intra-arterial injection or use of excessive amounts of drug. Toxic symptoms range from mild, such as as tinnitus, to more severe, such as convulsions, and further progression to cardiovascular collapse. This toxicity must be anticipated and treated appropriately. Our own institutional study showed an 89% success rate with axillary brachial plexus blocks used for hand and wrist procedures. However, the success rate dropped to 60% for surgery involving the elbow. These results were improved by the use of local anesthetic supplementation or intravenous sedation.     

Effects of exercise and anabolic steroids on total and lipoprotein cholesterol concentrations in male and female rats

Forty male and 40 female rats were randomly assigned to 1 of 4 experimental groups. Half of the animals of each gender were exercised by jumping (weighted by a vest with up to 70% body weight) to a height of 16 cm 20 times X d-1 (30 s between jumps) 5 d X wk-1 for 8 wk. Half of the exercised animals and half of the sedentary animals were injected with the anabolic steroid durabolin (0.2 mg in 0.1 ml sesame seed oil) 6 d X wk-1 for the last 3 wk of the 8-wk exercise program. The other animals were injected with 0.1 ml of sesame seed oil (as a placebo) on the same schedule. At the end of the 8-wk program, blood was drawn from the right atria of the anesthetized animals. Plasmas were analyzed for total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) concentrations. Low density lipoprotein cholesterol (LDL-C) concentration was estimated as the difference between these two parameters (TC - HDL-C). A three-factor analysis of variance (2 X 2 X 2) demonstrated that there was a significant (P less than 0.05) gender effect (males greater than females), but no steroid or exercise main effects for TC. There were significant (P less than 0.05) steroid and exercise main effects for both HDL-C and estimated LDL-C, as well as a significant gender main effect for estimated LDL-C (but not HDL-C).(ABSTRACT TRUNCATED AT 250 WORDS)