scholarly journals Differential Diagnostics of Toxic Epidermal Necrolysis (Lyell’s Syndrome) in ICU: Case Reports

2022 ◽  
Vol 18 (6) ◽  
pp. 97-104
Author(s):  
Yu. V. Molochkova ◽  
Zh. S. Philippovskaya ◽  
А. G. Kupriyanova ◽  
E. V. Mitina ◽  
O. V. Karzanov ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Intercellular Space ◽  
Case Reports ◽  
Diagnosis And Treatment ◽  
Differential Diagnostics ◽  
Stratum Granulosum ◽  
Icu Patients ◽  
Stratum Spinosum ◽  
Current Article ◽  
Skin Specimen

Toxic epidermal necrolysis (TEN) is a critical life-threating condition developing as the total detachment of epidermidis and characterized by severe pathological reactions of all body systems. The current article describes two cases of TEN with similar clinical and laboratory signs. In one case the diagnosis of TEN was subsequently refused.The objective: analysis of methods of clinical and differential diagnostics of conditions accompanied with massive epidermidis detachment in ICU patients.Results. The immunomorphological evaluation of skin specimen obtained from the patient with a torpid form of TEN showed linear IgG fixation in the intercellular space of stratum basale, stratum spinosum and stratum granulosum and C3 fixation in the intercellular space of stratum basale.Conclusion. The complex of anamnesis data and pathomorphological evaluation of skin are crucial for the diagnosis and treatment of patients with atypical TEN.

The Ultrastructure of Monkey Gingival Epithelium

1967 ◽  
Vol 25 ◽  
pp. 16-17
Author(s):  
C.N. Sun
Keyword(s):  
Epithelial Cells ◽  
Macaca Nemestrina ◽  
Stratum Granulosum ◽  
Solution Ph ◽  
Gingival Epithelial Cells ◽  
Stratum Spinosum ◽  
Cell Layers ◽  
Gingival Epithelium ◽  
The Individual ◽  
Different Thickness

The present study demonstrates the ultrastructure of the gingival epithelium of the pig tail monkey (Macaca nemestrina). Specimens were taken from lingual and facial gingival surfaces and fixed in Dalton's chrome osmium solution (pH 7.6) for 1 hr, dehydrated, and then embedded in Epon 812.Tonofibrils are variable in number and structure according to the different region or location of the gingival epithelial cells, the main orientation of which is parallel to the long axis of the cells. The cytoplasm of the basal epithelial cells contains a great number of tonofilaments and numerous mitochondria. The basement membrane is 300 to 400 A thick. In the cells of stratum spinosum, the tonofibrils are densely packed and increased in number (fig. 1 and 3). They seem to take on a somewhat concentric arrangement around the nucleus. The filaments may occur scattered as thin fibrils in the cytoplasm or they may be arranged in bundles of different thickness. The filaments have a diameter about 50 A. In the stratum granulosum, the cells gradually become flatted, the tonofibrils are usually thin, and the individual tonofilaments are clearly distinguishable (fig. 2). The mitochondria and endoplasmic reticulum are seldom seen in these superficial cell layers.

scholarly journals Challenges in Evaluation and Management of Children with Myocardial Bridging

Cardiology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Nurdan Erol
Keyword(s):  
Congenital Anomaly ◽  
Coronary Artery ◽  
Case Reports ◽  
Case Series ◽  
Diagnosis And Treatment ◽  
Myocardial Bridging ◽  
Small Case Series ◽  
Adults And Children ◽  
Artery Branch

Myocardial bridging (MB) is a congenital anomaly where a coronary artery branch or group of branches extends inside a tunnel consisting of myocardium. Although it is mostly considered “benign,” it is reported that MB may lead to significant cardiac problems and sudden cardiac deaths. While it is a congenital anomaly, its symptoms usually arise at further ages rather than childhood. The literature on MB in children is in the form of case reports or small case series. This is why pediatric cases are assessed in the light of information obtained from adults. This review compiled the literature on MB in adults and children and compared it, as well as discussing questions arising regarding the clinic, diagnosis, and treatment of MB.

scholarly journals Drugs Implicated, Mortality and Use of Corticosteroids in Toxic Epidermal Necrolysis Cases: A Systematic Review of Published Case Reports and Case Series

2014 ◽  
Vol 48 (3) ◽  
pp. 132-138
Author(s):  
Sunil Dogra ◽  
Samir Malhotra ◽  
Promila Pandhi ◽  
Sharonjeet Kaur ◽  
Sujit Rajagopalan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
Case Series ◽  
Developed Countries ◽  
Mortality Rates ◽  
The Past ◽  
Changing Trends ◽  
Nonsignificant Difference ◽  
Developing And Developed Countries

ABSTRACT Background Toxic epidermal necrolysis (TEN) is a rare idiosyncratic mucocutaneous reaction associated with high mortality. Drugs are most commonly implicated in TEN. The treatment constitutes stopping the offending drug, along with symptomatic management. In this study, we searched for case reports/series of TEN and analyzed data to find the most commonly implicated drugs in TEN, effects of use of corticosteroids on mortality in TEN patients, changing trends in mortality over the past 3 decades and difference in mortality rates in both developing and developed countries. Materials and methods We searched for case reports/series of TEN to evaluate most commonly implicated drugs in TEN, effects of use of corticosteroids on mortality in TEN patients, changing trends in mortality over the past three decades and difference in mortality rates in both developing and developed countries. Results Antibiotics (28.6%) followed by antiepileptics (17.4%) and nonsteroidal anti-inflammatory drugs (9.6%) are most commonly implicated. There was nonsignificant decrease in mortality among steroids users as compared to nonusers (OR = 2.0, CI 0.96-4.24). During the period between 1980 and 1989 the reported mortality in TEN cases was approximately 33.4%, which decreased to 27% in the next two decades. There was a nonsignificant difference in mortality in develo- ping countries as compared to developed countries (OR: 0.70, CI 0.32-1.53). Conclusion Corticosteroids have been associated with non significant reduction in the mortality. Apart from this, mortality did not differ over years together in both developing and developed countries. How to cite this article Kaur S, Rajagopalan S, Shafiq N, Dogra S, Srinivasan A, Pandhi P, Malhotra S. Drugs Implicated, Mortality and Use of Corticosteroids in Toxic Epidermal Necrolysis Cases: A Systematic Review of Published Case Reports and Case Series. J Postgrad Med Edu Res 2014;48(3):132-138.

BENIGN TUMORS BREAST GLASS

2021 ◽  
Vol 7 (2) ◽  
pp. 2-11
Author(s):  
Arif Guseynov ◽  
T. Guseynov ◽  
V. Odincov
Keyword(s):  
Surgical Treatment ◽  
General Practitioners ◽  
Clinical Picture ◽  
Relevant Information ◽  
Diagnostic Methods ◽  
Diagnosis And Treatment ◽  
Differential Diagnostics ◽  
Benign Tumors

The lecture provides relevant information for doctors of various specialties: oncologists, surgeons, mammologists, general practitioners on the problems of diagnosis and treatment of benign breast formations. The issues of etiology and pathogenesis, classification and clinical picture of various formations are highlighted, diagnostic methods, differential diagnostics, treatment tactics and methods of surgical treatment are described in detail.

Suspected Lamotrigine-Induced Toxic Epidermal Necrolysis

1997 ◽  
Vol 31 (6) ◽  
pp. 720-723 ◽  
Author(s):  
Julie J Chaffin ◽  
Steven M Davis
Keyword(s):  
Valproic Acid ◽  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
Stevens Johnson Syndrome ◽  
Complex Partial Seizures ◽  
Skin Reactions ◽  
Johnson Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Relationship Of

OBJECTIVE: To describe a patient who developed toxic epidermal necrolysis (TEN) possibly secondary to lamotrigine use. CASE SUMMARY: A 74-year-old white man with a history of probable complex partial seizures was admitted to the neurology service for a prolonged postictal state. His antiepileptic regimen was changed while he was in the hospital to include lamotrigine. After 19 days of hospitalization and 14 days of lamotrigine therapy, the patient became febrile. The next day he developed a rash which progressed within 4 days to TEN, diagnosed by skin biopsy. All suspected drugs were discontinued, including lamotrigine. The patient was treated with hydrotherapy in the burn unit. His symptoms improved and he was discharged from the hospital 26 days after the rash developed. DISCUSSION: During lamotrigine's premarketing clinical trials, the manufacturer reported several cases of Stevens-Johnson syndrome and TEN. There are several published case reports of lamotrigine-induced severe skin reactions. All of these reports included patients being treated with both valproic acid and lamotrigine. Our patient was exposed to phenytoin, carbamazepine, clindamycin, and lamotrigine, but not valproic acid. The patient reported prior use of phenytoin with no skin rash. Carbamazepine was the antiepileptic drug the patient was maintained on prior to his hospital admission, and the symptoms of TEN resolved while he was still receiving carbamazepine. The patient received only two doses of clindamycin, which makes this agent an unlikely cause of TEN. CONCLUSIONS: Because of the temporal relationship of the onset of the patient's rash and several drugs that are known to cause severe rashes, it is not certain which drug was the definite culprit. However, based on the evidence from the literature, lamotrigine appears to be the causative agent.

A Cautionary Tale of Etanercept Use in Patients With Toxic Epidermal Necrolysis

2020 ◽  
Author(s):  
Janie Faris ◽  
Jordan Wilson ◽  
Heather S Dolman ◽  
Andrew Isaacson ◽  
Alfred E Baylor ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
The United States ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cautionary Tale ◽  
Life Threatening ◽  
Positive Results ◽  
Severe Cutaneous Reaction ◽  
Necrosis Factor

Abstract Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction that can be life-threatening. In the United States, there are no established guidelines for the treatment of TEN. Supportive care including fluids and supportive therapies are the current recommendations. Research surrounding TEN involves mostly case studies or small, uncontrolled studies. Recent literature describes the use of tumor necrosis factor blockers in the treatment of TEN with positive results. These case reports describe decreased time to reepithelization, hospital length of stay, and minimal side effects. Conversely, we present three fatalities after the administration of etanercept.

Clonidine as a strategy for discontinuing dexmedetomidine sedation in critically ill patients: A narrative review

2020 ◽  
Vol 77 (7) ◽  
pp. 515-522
Author(s):  
Shelley S Glaess ◽  
Rebecca L Attridge ◽  
G Christina Gutierrez
Keyword(s):  
Observational Studies ◽  
Literature Search ◽  
Case Reports ◽  
Research Articles ◽  
Original Research ◽  
Loading Dose ◽  
Efficacy And Safety ◽  
Limited Data ◽  
Icu Patients ◽  
Dexmedetomidine Infusion

Abstract Purpose To review the efficacy and safety of transitioning from dexmedetomidine to clonidine to facilitate weaning of patients from sedation with dexmedetomidine. There is a paucity of data describing dexmedetomidine withdrawal syndrome (DWS) as well as clonidine’s place in therapy for DWS. This review will describe and analyze current literature to provide clinical recommendations. Summary A MEDLINE literature search was performed to identify original research articles describing DWS and/or transitioning from dexmedetomidine to clonidine for the purpose of weaning patients from sedation with dexmedetomidine. Four case reports describing DWS, 3 case reports describing the use of clonidine to treat DWS, and 3 observational studies describing the use of clonidine to facilitate dexmedetomidine weaning were identified. The incidence of and risk factors for DWS are unknown; factors including patient age and dexmedetomidine infusion rate, loading dose, and discontinuation strategy have inconsistent associations with DWS. All cases of DWS have been associated with infusion durations greater than 72 hours. While there are limited data describing clonidine use for the treatment of dexmedetomidine withdrawal, clonidine appears to be beneficial for dexmedetomidine weaning and its use for that purpose has been well described. Clonidine dosages that have been assessed for discontinuing dexmedetomidine vary from 0.1 to 0.3 mg orally or enterally every 6 to 8 hours; one study assessed use of transdermal clonidine (100 µg/24 h patch). Patients with extensive cardiac comorbidities may be more susceptible to adverse effects of clonidine, which may limit the drug’s use for DWS intervention. Conclusion Despite limited supportive data, clonidine provides a promising option for sedation management in adult ICU patients, with successful transitions from dexmedetomidine reported within 24 hours after clonidine initiation.

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