A Sandroni | PubMed Health

PubMedDate not supplied

Toxic epidermal necrolysis: does immunoglobulin make a difference?

Experimental evidence implicates Fas ligand-mediated keratinocyte apoptosis as an underlying mechanism of toxic epidermal necrolysis syndrome (TEN). In vitro studies indicate a potential role for immunoglobulin (Ig) therapy in blocking Fas ligand signaling, thus reducing the severity of TEN. Anecdotal reports have described successful treatment of TEN patients with Ig; however, no study to date has analyzed outcome data in a large series of patients treated with Ig using institutional controls. The SCORTEN severity-of-illness score ranks severity and predicts prognosis in TEN patients using age, heart rate, TBSA slough, history of malignancy, and admission blood urea nitrogen, serum bicarbonate, and glucose levels. A retrospective chart review was performed that included all patients treated for TEN at our burn center since 1997. Ig therapy was instituted for all patients with biopsy-proven TEN beginning in January 2000. Twenty-one TEN patients were treated before Ig (no-Ig group), and 24 patients have been treated with Ig. SCORTEN data were collected, as well as length of stay (LOS) and status upon discharge. Each patient was given a SCORTEN of 0 to 6, with 1 point each for age greater than 40, TBSA slough greater than 10%, history of malignancy, admission BUN greater than 28 mg/dl, HCO3 less than 20 mg/dl, and glucose greater then 252 mg/dl. Outcome was compared between patients treated with Ig and without Ig. Overall mortality for patients treated before Ig was 28.6% (6/21), and with Ig, mortality was 41.7%% (10/24). There was no significant difference in age or TBSA slough. The average SCORTEN between the groups was equivalent (2.2 in no-Ig group vs 2.7 in Ig group, P = 0.3), and no group of patients with any SCORTEN score showed a significant benefit from Ig therapy. Overall LOS as well as LOS for survivors was longer in the Ig group. This series represents the largest single-institution analysis of TEN patient outcome after institution of Ig therapy. Our data do not show a significant improvement in mortality for TEN patients treated with Ig at any level of severity and may indicate a potential detriment in using Ig. Ig should not be given to TEN patients outside of a clinical trial. A multicenter, prospective, double-blinded randomized trial is necessary and urgently indicated to determine whether Ig therapy is beneficial or harmful in the care of TEN patients.

Adult↗

PubMedDate not supplied

[Practical problems in supply and use of ultrasonic nebulizers at home for aerosol treatment of cystic fibrosis].

With the aim of evaluating the technical and administrative problems which are relevant to the home aerosol therapy through ultrasonic nebulizers in the management of cystic fibrosis (CF), a comparative study was performed on three types of devices. The study was carried out by means of a questionnaire on the basis of an intensive motivation of the users who were enrolled. The questionnaire was given to 36 families involved in the CF management: they were subdivided into 3 groups of twelve, to each one of whom one of the 3 types of devices had been prescribed. Thirty three families, 11 for each group, answered. With regard to the supply of the devices, an enormous delay was observed: on average from 48 to 111 days according to the groups. The major problems of endurance and maintenance were concerning the american nebulizer Devilbiss Ultranebb mod. 99, the highest costs regarded the German nebulizer Klava 5000. The users' comprehensive evaluation of the devices were fairly in accordance to the results concerning their endurance over time. However, the study showed also some defects of compliance in the patients and their families as regard to the disinfection of the instruments as prescribed by the care Center.

Aerosols↗