Post-acute phase and sequelae management of epidermal necrolysis: an international, multidisciplinary DELPHI-based consensus.

BACKGROUND: Long-term sequelae are frequent and often disabling after epidermal necrolysis (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)). However, consensus on the modalities of management of these sequelae is lacking. OBJECTIVES: We conducted an international multicentric DELPHI exercise to establish a multidisciplinary expert consensus to standardize recommendations regarding management of SJS/TEN sequelae. METHODS: Participants were sent a survey via the online tool "Survey Monkey" consisting of 54 statements organized into 8 topics: general recommendations, professionals involved, skin, oral mucosa and teeth, eyes, genital area, mental health, and allergy workup. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). Results were analyzed according to the RAND/UCLA Appropriateness Method. RESULTS: Fifty-two healthcare professionals participated. After the first round, a consensus was obtained for 100% of 54 initially proposed statements (disagreement index < 1). Among them, 50 statements were agreed upon as 'appropriate'; four statements were considered 'uncertain', and ultimately finally discarded. CONCLUSIONS: Our DELPHI-based expert consensus should help guide physicians in conducting a prolonged multidisciplinary follow-up of sequelae in SJS-TEN.

Clinical experience with the use of biodegradable tacks in pediatric patients with burns.

Stainless steel staples are very popular for securing grafts and dressings on patients with burns because of the speed and security with which they can be applied and the fact that stainless steel is nonreactive. In patients with large burns hundreds of staples are used and can be difficult to visualize and remove; they are therefore retained. Although stainless steel does not cause local tissue reaction, its presence can confuse the later evaluation of local pain. A new biodegradable tack has been developed. We describe an initial experience with this device in pediatric patients with burns and make suggestions regarding their use.

Recognition and management of hot liquid aspiration in children.

Although infrequently reported, aspiration of hot liquid can occur in conjunction with upper-body scald burns, leading to acute compromise of the small pediatric airway with clinical features similar to those of acute infectious epiglottitis. This can be a very difficult problem if subtle signs of impending airway compromise are not appreciated. Reported here are four such cases managed over a 3-year period at a regional pediatric burn center, emphasizing points of history and physical examination that facilitate early recognition of this life-threatening problem. Aspiration of hot liquid should be suspected in children with burns in or around the mouth, particularly if there are any subtle signs of upper airway edema. If this complication is suspected, immediate endotracheal intubation should be performed in those with acute respiratory embarrassment, and prompt investigation by direct laryngoscopy in the operating room is appropriate in those who have not yet developed overt respiratory distress.

A study on the erythrocyte aggregating properties of polybrene and protamine sulphate.

By observing the aggregation of erythrocytes in protamine sulphate or Polybrene it is possible to predict MN phenotypes with 97 per cent accuracy. It is probable that one factor influencing aggregation is the relative site density of a receptor common to both M and N antigen structures although other nondiscriminating receptor sites on a lower layer of sialic acid are possible also involved.