Acute generalized exanthematous pustulosis with lymphangitis triggered by a spider bite

Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous reaction pattern that, in the majority (>90%) of cases, is related to administration of medication. It can be seen in both genders and in all ages. The cutaneous manifestations of AGEP are usually seen 1–14 days after drug administration. A 39-year-old woman presented to our outpatient clinic with the complaint of generalized erythema, burning, and rash. She explained that 2 days before presentation a spider bite had occurred on her left forearm, after which she had experienced pain and erythema spreading gradually to the left upper extremity. On her dermatologic examination, she had an indurated necrotic plaque on the left forearm, which had an upward-spreading linear erythema. Additionally, she had diffuse erythema on her body and small pustules over erythematous skin, especially located on the left popliteal fossa and gluteal region. Based on the clinical and histopathologic findings, she was diagnosed as having AGEP. Because there was no drug use in her history, we attributed her AGEP lesions to the spider bite. This case is interesting, because the patient also had lymphangitis. Herein, we present the fifth case reported in the literature of AGEP caused by a spider bite.     

A patient with snakebite presenting with thrombophlebitis-like appearance and DIC

A snakebite is a serious and important problem in tropical and subtropical cities. A vast majority of snakebites are nonvenomous. However, venomous snakebites may cause local tissue destruction, neuroparalysis, systemic hemorrhage, generalized myotoxicity, and acute renal failure. A 10-year-old boy was brought to the emergency room with complaints of swelling, severe pain, and motionless left leg, developed as a result of a snakebite. After the extensive laboratory work-up, he was diagnosed with disseminated intravascular coagulation (DIC) and thrombophlebitis was ruled out. The antivenom treatment was administered and he improved dramatically within 3 days. A snakebite-induced DIC is a very rare complication and its presentation may mimic thrombophlebitis-like picture. A detailed and careful history taking will help to make an accurate diagnosis and, thus, an early proper management will be administered to rescue the patient’s life.     

有创-无创序贯机械通气救治蛇咬伤致呼吸衰竭的临床研究

目的探讨有创、无创序贯机械通气治疗蛇咬伤致呼吸衰竭的疗效。方法选取22例蛇咬伤并呼吸衰竭的患者予有创后脱机拔除气管插管序贯无创机械通气治疗。19例采用传统机械通气治疗,记录并分析比较两组间患者有创机械通气时间、住呼吸重症监护病房时间、总机械通气时间,总住院时间及呼吸机相关性肺炎(VAP))发生率、再插管率等。结果有创-无创序贯机械通气治疗蛇咬伤并呼吸衰竭疗效显著,有创通气时间、总通气时间及入住呼吸重症监护室(RICU)时间较传统组显著减少(P<0.05),VAP的发生率也明显减少(P<0.05)。拔管后均无需再插管,死亡率两组无差异。结论在患者蛇毒控制,呼吸肌麻痹逐渐改善,咳嗽有力的情况下,停有创,序贯无创治疗具有优越性。     

小儿输尿管异位开口的影像检查和诊断(附68例分析)

目的探讨小儿输尿管异位开口的影像检查方法及影像表现。方法回顾性分析68例小儿输尿管异位开口的临床资料及影像检查方法和影像表现。结果输尿管异位开口伴发重肾双输尿管畸形44例,伴发发育不全肾畸形24例。IVU检查全部显示了重肾的直接或间接征象,但对严重发育不全肾及异位开口的输尿管显示率较低。8例CT检查均显示了重肾或发育不全肾及其引流的输尿管。结论IVU检查结合临床表现多数病例能够作出输尿管异位开口的定性和定位诊断,少数病例需要辅以CT检查方可明确诊断。     

High Molecular‐Weight Cyclic Polyesters from Solvent‐Free Ring‐Opening Polymerization of Lactones with a Pyridyl‐Urea/MTBD

(Thio)urea/base systems have been widely used in the ring‐opening polymerization (ROP) of lactones based on their superior performance in activity and selectivity. Herein, a pyridyl‐urea ( 6C‐PU )/7‐methyl‐1,5,7‐triazabicyclo[4.4.0]dec‐5‐ene catalytic system is used to prepare the polyesters with cyclic topology via the ROP of lactones in the absence of initiator under solvent‐free conditions. The catalytic system shows high activity in the ROP of δ‐valerolactone (δ‐VL) and cyclic polyvalerolactones (PVLs) with high molecular weights and narrow molecular weight distribution are obtained despite the existence of some linear products generated during the precipitation process. The structure of the resulting polymers is determined by proton and carbon nuclear magnetic resonance spectra, matrix assisted laser desorption/ionization time of flight mass spectrometry, and intrinsic viscosity studies. A possible mechanism is proposed on the basis of NMR analysis and characteristics of polymerization. Thermal and mechanical properties of cyclic PVLs are investigated through differential scanning calorimetry, thermogravimetric analysis, and tensile test.     

Good Validity and High Internal Consistency of the Forgotten Joint Score-12 in Patients After Medial Opening Wedge High Tibial Osteotomy

BackgroundThe Forgotten Joint Score-12 (FJS-12) was originally developed to assess awareness of an artificial joint. Medial opening wedge high tibial osteotomy (MOWHTO), an alternative surgical method of knee replacement, is a joint-preservation surgery; therefore, joint awareness should be used to evaluate its clinical results. However, FJS-12 has not been validated as a tool to evaluate the postoperative results of MOWHTO. This study aimed to validate FJS-12 in MOWHTO.MethodsPatients with bilateral knee surgery, previous knee surgery, flexion contracture >15°, varus alignment >20°, and patients without plate removal surgery were excluded. Finally, 71 knees of 71 patients were analyzed, with a mean follow-up of 34.5 months. The FJS-12 score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained, and the floor and ceiling effect of each score was investigated. Cronbach’s α was calculated to determine the internal consistency of FJS-12. Spearman’s correlation coefficients between FJS-12 and KOOS were calculated to assess convergent validity.ResultsThere were ceiling effects in 3 KOOS subscales (symptoms [25.4%], pain [15.5%], and activities of daily living [25.4%]) but not in FJS-12 (8.5%). No floor effect was noted in any patient-reported outcome measures. The total Cronbach’s α was 0.9457 in FJS-12. FJS-12 showed moderate-to-strong positive correlations with all KOOS subscales (r = 0.64-0.72).ConclusionFJS-12 showed a lower ceiling effect than KOOS and high internal consistency and convergent validity in patients following MOWHTO. With its low ceiling effect, FJS-12 was found to be useful for evaluating patients following MOWHTO.     

Trismus and oral health conditions during diagnosis of malignant oral neoplasms

IntroductionTrismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor.ObjectiveIn this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment.MethodsThis review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35 mm.ResultsTrismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann–Whitney non-parametric test. All tests were performed at p < 0.05.ConclusionEdentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.