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.     

女性慢性下腹痛的干预性治疗

1背景 育龄妇女常见慢性下腹痛，可造成身体损害、情绪忧伤及导致巨大的健康服务费用。美国在这方面的花费超过8亿8千万美元（Mathias 1996）。英国全国数据库的一般性诊治资料显示，慢性下腹痛发病率及流行率与偏头痛、背部痛、哮喘发病率相似（Zondervan 1999）。     

Accuracy of Spring and Strain Gauge Hand-held Dynamometers

The accuracy of two spring gauge and two strain gauge hand-held dynamometers was determined using certified weights. Each dynamometer, which had extensive prior use, was vertically loaded with the certified weights in 5 lb increments from 5-55 lbs. Analysis of variance was used to compare the actual certified weights with the weights measured by each dynamometer. Additionally, Pearson product moment correlations were calculated between the weights measured by each device. The two spring gauge dynamometers measured comparably as did the two strain gauge dynamometers. Only the two strain gauge dynamometers, however, registered (measured) weights not differing significantly from the actual weights with which they were loaded. The correlations between each device's measurements were 0.98 or above. If the dynamometers tested are indicative, strain gauge dynamometers may be more accurate than spring gauge dynamometers after extensive use. J Orthop Sports Phys Ther 1989;10(8):323-325.