Biomedical subjects
Publications and source records attributed to H N Robinson.
We report a case of pneumococcal septicemia in an asplenic, otherwise healthy, 31-year-old patient. He presented with a viral prodrome and skin findings of purpura and livedo reticularis. Blood cultures identified Streptococcus pneumoniae. Rapid initiation of appropriate therapy resulted in resolution of the infection and clearing of all skin signs.
We believe this to be the first report of a unilateral mixed appendageal tumor without comedones on the face of an infant. Histologically, the tumor had eccrine, apocrine, and basaloid features. The tumor lobules closely resembled islands of basal cell carcinoma. After reviewing the literature, we speculate that some previous case reports of unilateral basal cell nevus were actually appendageal tumors with basaloid differentiation and not true basal cell carcinomas.
Chronic photosensitivity associated with hydrochlorothiazide ingestion occurred in four patients. These patients developed a debilitating photosensitivity that persisted for months to years even after they stopped taking the diuretic. Their age range was 44 to 66 years. Phototesting with ultraviolet B (UV-B) and ultraviolet A (UV-A) radiation revealed decreased minimal erythemal doses for one or both wave bands in all patients tested. Histologic examination of skin biopsy specimens from the patients' UV-B and UV-A test sites and lesional skin revealed an acute eczematous dermatitis. Treatment with methoxsalen and UV-A radiation successfully cleared the photosensitive eruption in the patients.
Sixteen consecutive patients, nine of whom also had inhalation injury, had burns over 72% body surface area or more. The expected death rate was 94%. In fact, all of the eight patients still alive after 48 hours survived. The early deaths were primarily due to inhalation injury, the treatment of which remains an unsolved problem. A mixture of cerium nitrate and silver sulfadiazine was used for topical wound antisepsis. The wound flora was sparse: 447 of 814 wound-surface cultures were sterile; Gram-negative bacteria were recovered in 13%. This efficacious wound bacteriostasis appeared primarily responsible for the absence of late death.
Burn shock in infants and children is satisfactorily treated by the initial intravenous administration of balanced hypertonic sodium solutions; monitoring of plasma sodium and/or osmolarity permits necessary adjustment of the sodium concentration of administered fluids. This approach has been safe. Its principal advantage is in minimizing acute gains in body weight, which may be alarming otherwise, especially in children. Clinical and bacteriological data are presented indicating that cerium nitrate-silver sulfadiazine cream is a highly efficient topical antiseptic agent for both major and minor burn wounds and that it has low toxicity. Cerium nitrate-silver sulfadiazine cream can be readily employed in any clinical setting.