27 years of a single burn centre experience with Stevens-Johnson syndrome and toxic epidermal necrolysis: analysis of mortality risk for causative agents.

INTRODUCTION: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life threatening unwanted side effects, mainly from medication. Pathophysiology is still being debated. The disease usually requires treatment in burn units. PATIENTS AND METHODS: In a retrospective study over 27 years we evaluated 72 patients admitted with SJS, SJS/TEN and TEN to our burns unit. Patients were evaluated for age, gender, total body surface area (TBSA) involved, causing agents, blood transfusion, dialysis, steroid administration, intubation, length of intensive care stay and death rate. Participants were grouped according to TBSA from 0 to 10, 11 to 30, and 31 to 100% and also into causing agent. Statistical analysis was done using a step-wise regression analysis. Because of small sample sizes for each drug group the percentage of related death rates for each drug group was calculated. RESULTS: The highest incidence of SJS and TEN was in the age group of 61-70 years. Overall mortality was 38%, mainly due to sepsis. For each subgroup SJS/TEN overlap had the highest mortality. The highest mortality for causing agents was found from antibiotic treatment, the lowest from using non-steroidal anti-inflammatory drugs. Most transfusions were done in the antibiotic group also the group underwent the highest number of dialysis events. Step-wise regression analysis identified dialysis, mechanical ventilation and age over 65 years as mortality high risk factors. CONCLUSION: When SJS/TEN is caused by antibiotics suspicion of developing a fatal sepsis should be high. Patients' medical condition when initiating therapy with a potential causing agent also might influence medical outcome.

[Saarland Growth Study: analyses of body composition of children, aged 3 to 11 years. Measurement of height, weight, girth (abdomen, upper arm, calf) and skinfolds (triceps, biceps, subscapular,suprailiacal, abdominal) and bioelectric impedance (BIA)]. / Saarländische Wachstumsstudie: Analysen zur Körperzusammensetzung bei Kindern im Alter zwischen 3 und 11 Jahren. Messung von Körperhöhe, Körpergewicht, Umfängen (Abdomen, Oberarmen und Waden), Hautfettfalten (Trizeps, Bizeps, subskapular, suprailiakal und abdominal) und bioelektrischer Impedanzanalyse (BIA).

This study aimed to set up current reference charts of anthropometric data in the Saarland. Only national and international data were available to be compared but no former Saarland charts could be found. In the period between 1994 and 1995 we investigated children of 3 to 11 years in a cross-sectional study. Therefore we measured body height, weight, circumferences, skinfolds and bioelectrical impedance (BIA). No significant gender differences were found for body height and weight. Boys of all groups of age showed bigger abdominal circumferences than girls of the same age. On the other hand upper-arm and calf-girth of younger girls were larger than that from boys. In higher age groups circumferences become rather equal. The skinfolds of Saarland girls are thicker than those of boys. The urban rural comparison indicated no significant differences. Nor was any social divergence found among the aforementioned parameters. Regarding height Saarland children are seen to be similar or somewhat shorter than those examined in national or international studies. By the way, in higher percentiles the children in our study were heavier. Thus high BMI values of our study are bigger compared with former studies. According to the definition of obesity by the ECOG almost 20 to 30% of our children are obese. The older children become the higher is the percentage of obesity. Comparing girls and boys, bioelectrical impedance shows higher values for girls. In higher age classes resistance levels gets smaller, in boys more so than in girls. Body fat estimated by a formula based on BIA test parameters yielded negative values. So we propose the use of sex- and age-specific raw charts of BIA test parameters.

[Saarland Growth Study: percentile charts for height, weight, and body mass index (BMI) for boys and girls, 4-18 years old, in Saarland]. / Saarländische Wachstumsstudie: Perzentilenkurven für Körperhöhe, Körpergewicht und Body Mass Index (BMI) für saarländische Jungen und Mädchen im Alter zwischen 4 und 18 Jahren.

In a cross-sectional study dating from april 94 to march 96 we have investigated length and weight of 2610 girls and 2865 boys (age 4-18 years) at nursery schools and schools in Saarland. Thus we could provide first normative data for this region of Germany. Compared with data that have been collected between 1968 and 1989 at Dortmund, Bonn, Hamm and Jena, we found an increase in height of 2 cm for girls and boys aged 15-18 years. Apart from this finding, no further differences have been observed. Compared with international data, 18-year-old females and males in Saarland show large body heights: their average heights were 169 and 182 cm, respectively. Unfortunately, body weight of children of the Saarland is high, too. Children in Saarland were on average 1.5-6.6 kg heavier than those of the Dortmund study or other international studies. Studies have revealed that, according to the ECOG criteria, people of the Saarland are more obese than in other European countries. As a consequence of our study we request an institution for auxology to be founded which enables immediate reaction. This not only implies medical view points but also practical aspects of daily life (e.g. height of chairs or tables at schools). It is important to note that no changes have been made so far. Standards for height and weight should be updated every ten years. This should be a collaborative task between public health services and pediatric endocrinologists.

[Strategy for defect coverage in extensive degloving and crush injuries of 4 fingers]. / Strategie der Defektdeckung bei ausgedehnten Ablederungs- und Quetschverletzungen von vier Fingern.

Severe crush injuries with avulsion require specific treatment strategies. Usually we find complete loss of soft tissue, nerves and vessels, where only tendons and parts of the phalanges are preserved. Primary reconstructive procedures are usually not possible due to the complexity of the injury with severely destroyed structures. Bone shortening should be avoided in order to maintain finger length and motion. Therefore, emergency soft-tissue coverage represents the first step. Later, sensibility and mechanical stability of the skin should be restored. In our clinic, seven patients with this injury pattern were treated. Three cases involved four finger crush-avulsion injuries. In all cases, we performed a primary soft-tissue coverage with a pedicled flap. In a second session, the skin areas of the first web space of both feet were transplanted as neurovascular flaps. With this strategy, a useful hand function could be restored. The functional results are described and advantages and disadvantages of various techniques discussed.