Pemphigus Therapy with Oral Prednisolone Regimens A 5-Year Study

Twenty-two newly diagnosed patients with pemphigus were randomly divided into two groups of 11 each. One group was placed on a high-dose prednisolone (120 mg/day) therapy and the other group on a low-dose (60 mg/day) therapy. The patients were followed for 5 years. Although a rapid initial control of the pemphigus appeared to be achieved with the high-dose regimen, this regimen did not have any long-term benefit over the low-dose regimen with respect to the frequency of relapse or in the incidence of complications.     

The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients

We carried out a study to estimate the incidence of erythema multiforme (EM), Stevens Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) requiring hospitalization and to determine which drug therapies were associated with these reactions. We reviewed the clinical records of all patients who were hospitalized with these discharge diagnoses at Group Health Cooperative (GHC) of Puget Sound, Seattle, Wash, from 1972 through 1986. During this 14-year period, an average of about 260,000 persons, with demographic characteristics similar to those of the general population, received their care from GHC, and there were about 25,000 admissions to hospitals per year at the GHC hospitals. Based on International Classification of Diseases-Adapted coding, a total of 61 suspect cases of EM, SJS, or TEN were identified from the computerized hospital discharge file. Based on record review and the application of a uniform set of diagnostic criteria, a total of 37 patients (61%) were classified as having EM, SJS, or TEN. Of these, 16 cases (43%) were attributed to drugs administered to these patients prior to hospitalization. The overall incidence of hospitalization for EM, SJS, or TEN due to all causes was 4.2 per 10(6) person-years. The incidence of TEN alone due to all causes was 0.5 per 10(6) person-years. The incidence of EM, SJS, or TEN associated with drug use were 7.0, 1.8, and 9.0 per 10(6) person-years, respectively, for persons younger than 20 years of age, 20 to 64 years of age, and 65 years of age and older. Drug therapies with reaction rates in excess of 1 per 100,000 exposed individuals include phenobarbital (20 per 100,000), nitrofurantoin (7 per 100,000), sulfamethoxazole and trimethoprim, and ampicillin (both 3 per 100,000), and amoxicillin (2 per 100,000). Overall, our data suggest that cases of EM, SJS, and TEN sufficiently severe to require hospitalization are infrequent among outpatients using well-established drug therapies. A continuing challenge is the evaluation of these severe cutaneous reactions that are associated with newly marketed or less frequently prescribed drug therapies.     

Standardizing Postoperative Complications—Validating the Clavien-Dindo Complications Classification in Cardiac Surgery

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关于空腹血糖、空腹胰岛素乘积的倒数在流行病学研究中应用的补充说明

高胰岛素正糖钳夹技术可以测定活体的胰岛素敏感性,但它并不适用于大规模流行病学研究。流行病学研究需要简单的胰岛素抵抗测定法。本文补充报告在空腹血糖(FPG)(75～306mg/dl或4.2～17.1mmol/L)及空腹胰岛素(FIns)(9.7～120mU/L)范围很宽的Pima印第安人群中,正糖钳夹技术测定的胰岛素介导的葡萄糖代谢率(M)与涉及FPG、FIns的多种复合的胰岛素敏感指数的相关性:胰岛素作用指数(IAI)=1/(FPG×FIns)在非糖尿病人群及2型糖尿病人群都与M显著正相关(r>0.7,P=0.0001),而且这两者的相关性强于M与其他指数如FIns或FPG/FIns比值的相关性,也不弱于M与糖负荷后3～5个时间点的血糖、胰岛素曲线下面积乘积的相关性。IAI的五分变量分布情况表明有90.4%的IAI落在所预测的M值五分变量区域或与之相邻的一个五分变量区域之内。1/FPG×FIns虽相对简单但确实与机体的胰岛素敏感性密切相关,它可以做为胰岛素敏感指数在流行病学研究中应用。