Subject(s)
Bacterial Proteins/biosynthesis , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae/enzymology , Plastic Surgery Procedures , Postoperative Complications/diagnosis , beta-Lactamases/biosynthesis , Adult , Aged , Aged, 80 and over , Drug Resistance, Microbial , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/microbiology , Female , Humans , Male , Middle Aged , Portugal , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Risk FactorsABSTRACT
Stevens-Johnson syndrome (SSJ) and toxic epidermal necrolysis (TEN) correspond to an acute and rare life-threatening mucocutaneous reaction. We describe the etiology, length of stay, comorbidities and mortality of TEN in our hospital in a retrospective study of 12 years. Twenty-one patients were included in the study. The mean age was 66 years: 57.1% were females. One third had mucosal surface involvement. Median TBSA of epidermal detachment was 66% on day 1. Forty-two per cent had a SCORTEN at admission of 3 and 28.6% had a SCORTEN of 4, which performs 70.6% with SCORTEN ≥5. The most common causes of SJS/TEN in this study were antibiotics. There were a total of 15 deaths (71.4%). All the patients in the antibiotic group died. Patients who needed invasive ventilation had higher mortality (91%) than the non-invasive ventilation group (50%) and the group on spontaneous ventilation (42.8%). The most common complications were sepsis (53%) and renal failure (23%). Highest mortality due to sepsis was in the antibiotic group. When SCORTEN score was calculated for each patient, statistical evaluation showed an increase in mortality with increasing final score. The most crucial interventions are discontinuation of the causative drug and immediate referral to a burn unit, which helps in early diagnosis and decreases mortality. Our study provides insights into the confirmation of the risk of SJS/TEN as well as its treatment. When SSJ/TEN is caused by antibiotics, the suspicion of developing fatal sepsis should be high regardless of the patient's medical condition.
Le syndrome de Stevens-Johnson et la nécrolyse épidermique toxique (NET) consistent en une réaction cutanéo-muqueuse grave rare. Nous décrivons de manière rétrospective l'étiologie, la durée de séjour, les complications et la mortalité des 21 patients hospitalisés dans notre service pour TEN pendant 12 ans. L'âge moyen des patients était de 66 ans, 57,1% étaient des femmes. Le tiers des patients avaient des atteintes muqueuses. La surface décollée moyenne à J1 était de 66%. Le SCORTEN à l'admission était à 3 chez 42% des patients, 4 chez 28,6% soit 70,6% avec SCORTEN ≤ 5. Les médicaments les plus souvent en cause étaient les antibiotiques. Quinze patients (71,4%) sont décédés, parmi lesques tous ceux dont le TEN était lié à un antibiotique. Les patients nécessitant une ventilation invasive sont morts dans 91% des cas, ceux sous VNI dans 50% des cas, ceux qui n'ont pas été ventilés dans 42,8% des cas. Les complications les plus fréquentes étaient le sepsis (53%) et l'insuffisance rénale (23%). La mortalité reliée au sepsis était plus fréquente dans le groupe des NET déclenchés par un antibiotique. Elle était reliée au SCORTEN. L'arrêt du médicament en cause et l'hospitalisation immédiate en CTB permettent un diagnostic plus précoce et une réduction de la mortalité. Cette étude donne des éclairages sur les risques de SJS/NET et leur traitement. Quand ils sont dus à un antibiotique, le danger de décéder par sepsis est élevé, quel que soit l'état initial du patient..
Subject(s)
Biofuels , Energy-Generating Resources , Microalgae/chemistry , Bioreactors , Hot Temperature , Species Specificity , Time FactorsSubject(s)
Adenocarcinoma/diagnosis , Gallbladder Neoplasms/diagnosis , Aged , Aged, 80 and over , Female , Gallbladder Neoplasms/epidemiology , Humans , Male , Middle AgedABSTRACT
No disponible
Subject(s)
Middle Aged , Aged , Aged, 80 and over , Male , Female , Humans , Adenocarcinoma , Gallbladder NeoplasmsABSTRACT
We report on an HIV positive patient with bilateral primary renal non-Hodgkin lymphoma that remitted with chemotherapy. The clinical and radiological features, which are initially not distinct from those of other tumors in the same site, and the therapeutic possibilities are discussed.
Subject(s)
HIV Seropositivity , Kidney Neoplasms , Lymphoma, AIDS-Related , Lymphoma, Non-Hodgkin , Adult , Humans , Kidney Neoplasms/diagnosis , Lymphoma, AIDS-Related/diagnosis , Lymphoma, Non-Hodgkin/diagnosis , MaleABSTRACT
Prostate T.C.T. is a rare tumour representing about 1% of all prostate tumours. Out of 435 patients diagnosed in our prostate cancer service between 1975 and 1988, only 2 presented the features of transitional carcinoma of prostatic ductus coexisting in both cases with a glandular type tumour (0.45%). Both cases were treated in a palliative way through R.T.U. and hormonotherapy, also performing in one case telecobalto-therapy. The two cases presented had a very poor evolution, and die 6 month after diagnosis due to tumoral progression with a widespread bone metastasis, blastic in one case and mixed in the other one.
