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）。     

USE OF ATRACURIUM OR VECURONIUM TO PROLONG THE ACTION OF TUBOCURARINE

Forty patients received tubocurarine in a dose greater thanED₉₀. When neuromuscular function had recovered to amplitudeof the first contraction of the train-of-four equals 10% ofcontrol, a small increment of atracurium or vecuronium was administered,repeating the same increment at each subsequent recovery to10%. The intensity and duration of the neuromuscular block followingthe first increment was always greater than that of subsequentincrements. The duration and intensity of the block was progressivelyreduced with subsequent increments until the responses to furtherincrements were unchanged. These final means at steady statewere: group 1 (atracurium 1.1 mg) 6.4 (0.3) min; group 2 (atracurium2.0 mg) 8.2 (0.9) min; group 3 (vecuronium 0.25 mg) 5.8 (0.4)min; group 4 (vecuronium 0.5 mg) 13.2 (0.4) min.     

The effects of aminosalicylic acid derivatives on nitric oxide in a cell-free system

Aims and Methods: To determine the effect of aminosalicylic acid derivatives on the concentration of nitric oxide produced in a cell-free system, by the use of a sensitive and specific polarographic meter. Results: The aminosalicylic acid derivatives 3-ASA (IC₅₀ 100 μm ), 4-ASA (IC₅₀ 350 μm ) and 5-ASA (IC₅₀ 5 μm ) all decreased the nitric oxide signal. These drugs had a similar inhibitory effect on the formation in vitro of nitrite from sodium nitroprusside (IC₅₀ 200 μm , 500 μm and 100 μm , respectively). Sulphasalazine (31.1 ± 5% decrease in signal at 1 mm ) was less effective than 5-ASA, but sulphapyridine, N-acetyl 5-ASA, indomethacin and hydrocortisone produced no decrease in nitric oxide signal at all. Conclusions: Nitric oxide binding may be part of the mechanism by which ASA derivatives exert their therapeutic effect, and this work suggests that it may be an important factor in the pathogenesis of ulcerative colitis.