A rare cutaneous tumour.

A clinicopathological correlation case of a rare cutaneous tumour, which demonstrated a very rare recurrence with uncertainty remaining over the long-term prognosis for the patient. Click https://www.wileyhealthlearning.com/#/online-courses/a975ab43-2d48-46fb-8dba-7df9792fd778 for the corresponding questions to this CME article.

Costs and resource utilization patterns in surgical site infections: a pre-COVID-19 perspective from France, Germany, Spain, and the UK.

BACKGROUND: Surgical site infections (SSIs), mainly caused by Staphylococcus aureus, pose a significant economic burden in Europe, leading to increased hospitalization duration, mortality, and treatment costs, particularly with drug-resistant strains such as meticillin-resistant S. aureus. AIM: To conduct a case-control study on the economic impact of S. aureus SSI in adult surgical patients across high-volume centres in France, Germany, Spain, and the UK, aiming to assess the overall and procedure-specific burden across Europe. METHODS: The SALT study is a multinational, retrospective cohort study with a nested case-control analysis focused on S. aureus SSI in Europe. The study included participants from France, Germany, Italy, Spain, and the UK who underwent invasive surgery in 2016 and employed a micro-costing approach to evaluate health economic factors, matching S. aureus SSI cases with controls. FINDINGS: In 2016, among 178,904 surgical patients in five European countries, 764 developed S. aureus SSI. Matching 744 cases to controls, the study revealed that S. aureus SSI cases incurred higher immediate hospitalization costs (€8,810), compared to controls (€6,032). Additionally, S. aureus SSI cases exhibited increased costs for readmissions within the first year post surgery (€7,961.6 versus €5,298.6), with significant differences observed. Factors associated with increased surgery-related costs included the cost of hospitalization immediately after surgery, first intensive care unit (ICU) admission within 12 months, and hospital readmission within 12 months, as identified through multivariable analysis. CONCLUSION: The higher rates of hospitalization, ICU admissions, and readmissions among S. aureus SSI cases highlight the severity of these infections and their impact on healthcare costs, emphasizing the potential benefits of evidence-based infection control measures and improved patient care to mitigate the economic burden.

Porokeratosis ptychotropica: a lesser-known variant.

We report a case of the rare porokeratosis variant porokeratosis ptychotropica (PP). A circumferential perianal plaque and the characteristic histology of multiple cornoid lamellae with underlying dermal amyloid deposition were seen. Amyloid deposition was seen in the biopsied intertriginous area of the plaque only, which, in concordance with other cutaneous amyloid deposition disorders, may suggest a role for friction in the pathogenesis of this histological finding. We review the literature on PP and summarize the poor response seen to treatments.

Flagellate erythema induced by docetaxel.

Docetaxel is a commonly used taxane in chemotherapy treatment. A reported 70% of infusions are associated with skin reactions. We report a case of flagellate erythema after treatment with docetaxel. Although flagellate erythema has been reported previously with bleomycin and peplomycin, to our knowledge this is the first description of flagellate erythema induced by docetaxel, and should be added to the list of causes of this skin reaction. Oral corticosteroid treatment may prevent its appearance.

Peculiarities of PAPA syndrome.

OBJECTIVES: To describe a family from New Zealand with the pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, an autoinflammatory, variably expressed, erosive destructive form of arthritis. METHODS: Information was gained through medical records and interviews of the affected patients and wider family. DNA sequencing was performed at Seay Center for Musculoskeletal Research Texas Scottish Rite Hospital for Children. RESULTS: Five patients were affected over three generations with an E250Q mutation found on the CD2BP1 gene on chromosome 15. Common features included a severe, pauciarticular-onset, destructive peripheral arthritis, beginning at ages 5, 5, 2, 3 and 1(1/2) years. This combination marked cervical ankylosis (in two members), micrognathia and a more severe phenotype is unique. A third-generation family member treated early with DMARDs is following a less severe course. The skin involvement was variable, all with degrees of acne from puberty, though only one patient displayed pyoderma gangrenosum. A clear pattern of the arthritis switching off in adolescence and the triggering of skin disease was observed. CONCLUSIONS: Differing degrees of joint destruction, and cervical ankylosis in this family with the E250Q mutation demonstrate PAPA syndrome's variable expression. Further understanding of this rare condition and its pathway may allow better targeting of treatments, not just for families with this specific syndrome but also for other, more common, forms of arthritis.

Probabilidad de supervivencia en traumatismos graves. Análisis del modelo TRISS en un registro hospitalario / Probability of survival after severe trauma: analysis of the TRISS methodology in a hospital registry

Introducción. La creación desde los años ochenta de amplias bases de datos de pacientes traumatizados ha hecho posible el desarrollo y validación, mediante el empleo de modelos estadísticos de regresión logística, de unas normas de probabilidad de supervivencia basadas en las escalas de gravedad del traumatismo. Pacientes y métodos. Hemos analizado, mediante el modelo TRISS, que combina los valores del RTS, ISS, la edad del paciente y el tipo de traumatismo (cerrado o penetrante), la probabilidad de supervivencia (Ps) (mortalidad esperada) de los pacientes con traumatismo grave (n = 464) recogidos en nuestro registro entre junio de 1993 y julio de 1997, comparándola con la mortalidad observada. La rentabilidad diagnóstica del modelo la hemos evaluado mediante el uso de curvas ROC para el traumatismo cerrado y el penetrante. Sobre la base del cálculo de la probabilidad de supervivencia hemos determinado el número de muertes inesperadas (pacientes que fallecen a pesar de tener una Ps > 0,50) y también de supervivencias inesperadas. Resultados. El área bajo la curva ROC fue de 0,84 y 0,89 para el traumatismo cerrado y el penetrante, respectivamente. La mortalidad global fue del 23,7 por ciento, para una mortalidad esperada del 28,6 por ciento según el modelo TRISS. En el traumatismo cerrado la mortalidad observada fue del 27,5 por ciento, frente a una mortalidad esperada (Ps 0,50) por traumatismo cerrado y dos por traumatismo penetrante. Conclusiones. El modelo TRISS tiene, en nuestro registro de traumatismo grave, una sensibilidad predictiva de evolución final que es alta en el traumatismo penetrante y bastante menor en el traumatismo cerrado. Puede ser útil para analizar individualmente las muertes potencialmente evitables, así como para el control de la calidad asistencial a nuestros pacientes traumatizados (AU)