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Am J Psychiatry 2002 Aug;159(8):1436
Publication Types:
PMID: 12153846, UI: 22148302
Other Formats:
Am J Psychiatry 2002 Aug;159(8):1435
PMID: 12153844, UI: 22148300
Arch Dermatol 2002 Aug;138(8):1091-6
University of Arizona Health Center, Tucson, USA.
PMID: 12164751, UI: 22154844
Arch Dermatol 2002 Aug;138(8):1019-24
Department of Biostatistics and Epidemiology, Institut Gustave-Roussy, Villejuif, France.
BACKGROUND: It was proposed that Stevens-Johnson syndrome and toxic epidermal necrolysis differed from erythema multiforme majus by the pattern and localization of skin lesions. OBJECTIVE: To evaluate the validity of this clinical separation. DESIGN: Case-control study. SETTINGS: Active survey from 1989 to 1995 of 1800 hospital departments in Europe. PATIENTS: A total of 552 patients and 1720 control subjects. METHODS: Cases were sorted into 5 groups (erythema multiforme majus, Stevens-Johnson syndrome, Stevens-Johnson syndrome-toxic epidermal necrolysis overlap, toxic epidermal necrolysis, and unclassified erythema multiforme majus or Stevens-Johnson syndrome) by experts blinded as to exposure to drugs and other factors. Etiologic fractions for herpes and drugs obtained from case-control analyses were compared between these groups. RESULTS: Erythema multiforme majus significantly differed from Stevens-Johnson syndrome, overlap, and toxic epidermal necrolysis by occurrence in younger males, frequent recurrences, less fever, milder mucosal lesions, and lack of association with collagen vascular diseases, human immunodeficiency virus infection, or cancer. Recent or recurrent herpes was the principal risk factor for erythema multiforme majus (etiologic fractions of 29% and 17%, respectively) and had a role in Stevens-Johnson syndrome (etiologic fractions of 6% and 10%) but not in overlap cases or toxic epidermal necrolysis. Drugs had higher etiologic fractions for Stevens-Johnson syndrome, overlap, or toxic epidermal necrolysis (64%-66%) than for erythema multiforme majus (18%). Unclassified cases mostly behaved clinically like erythema multiforme. CONCLUSIONS: This large prospective study confirmed that erythema multiforme majus differs from Stevens-Johnson syndrome and toxic epidermal necrolysis not only in severity but also in several demographic characteristics and causes.
PMID: 12164739, UI: 22154832
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BMJ 2002 Jul 27;325(7357):220; discussion 220
PMID: 12142317, UI: 22137467
Hum Exp Toxicol 2002 Jun;21(6):293-5
Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. mahilalf@lycos.com
[Medline record in process]
Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleander poisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining the outcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female = 55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases.
PMID: 12195932, UI: 22183593
J R Soc Med 2002 Jul;95(7):376
Personal Name as Subject:
Postgrad Med 2002 Aug;112(2):89-92, 95-6, 98
Infectious Diseases Service, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA. dlblazes@bethesda.med.navy.mil
Toxin-mediated diseases have made humans ill for millennia. They also have been used in beneficial ways. Unfortunately, the use of biological agents as weapons of terror has now been realized, and separating naturally occurring disease from bioterroristic events has become an important public health goal. The key to timely identification of such attacks relies on education of primary care physicians, first responders, and public health officials. We must remain vigilant to unusual case presentations or clusters of similar cases and report them immediately to public health authorities.
PMID: 12198756, UI: 22187641
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