A 66-year-old woman with toxic epidermal necrolysis and a fatal course

Article Abstract:

A 66-year-old woman was admitted to a hospital burn unit with a peeling rash over 85% of her body. She had a history of chronic kidney failure and arthritis, for which she took corticosteroids. Six weeks before admission, she had started methotrexate for her arthritis. Three weeks later she developed ulcers in her mouth and throat and was admitted to a hospital. She developed skin lesions on her back, which spread to the rest of her body except her legs, and eventually the skin began to peel away. She was given antibiotics and transferred to a burn unit. Blood cultures revealed infection with Klebsiella pneumoniae. CT scans showed lung and brain abnormalities. She died 27 days after admission to the burn unit. At autopsy, her skin had peeled away over 90% of her body. Examination of lung and brain tissue revealed extensive fungal infection with Aspergillus fumigatus. The destruction of her outer skin layer was probably caused by one of the drugs she was taking.

Case studies, Toxic epidermal necrolysis, Aspergillosis

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Initial management of ingestions of toxic substances

Article Abstract:

Patients suffering from a drug overdose should receive the proper treatment during the first hour after arrival at the emergency room. The highest priorities during this time are to ensure that the patient is able to breath and that vital signs are stable. Health care workers should diagnose drug overdose patients based on a detailed physical examination and conversations with family and friends. Information obtained from drug overdose patients themselves is often unreliable. Certain symptoms are characteristic of different drugs. Patients will not always need to have their stomach emptied; activated charcoal is usually the best treatment. Patients are usually treated before laboratory results are obtained. A complete laboratory analysis of blood, urine or stomach contents is done only for a select few patients. Antidotes may be given to patients during the first hour of treatment to neutralize the drug or drugs that have been ingested.

Drugs, Overdose, Toxicological emergencies, Self-poisoning, Self poisoning

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A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs

Article Abstract:

An intra-arterial infusion of a thrombolytic drug may prevent the need for surgery in patients with arterial occlusion of the legs. This condition is caused by blood clots in the legs, which can be broken down by thrombolytic drugs. Researchers compared infusions of the thrombolytic drug urokinase with surgical removal of the clots in 544 patients with arterial occlusions. Patients in the surgery group had 551 operations overall within six months, compared to 315 operations in the urokinase group. Patients who received urokinase had a higher risk of hemorrhage but amputation rates were similar in both groups.

Evaluation, Surgery, Leg, Thrombolytic therapy, Arterial occlusions, Arterial occlusive diseases, Urokinase

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