[Streptococcal impetigo at topical tacrolimus application sites in a woman with atopic dermatitis]. / Impétigo streptococcique apparu sur les sites d'application du tacrolimus chez une jeune atopique.

BACKGROUND: We report a case of staphylococcal impetigo in a girl treated with tacrolimus ointment (Protopic) for atopic dermatitis. OBSERVATION: A 15 year-old girl was receiving treatment with tacrolimus 0.03% (Protopic) for an episode of atopic dermatitis. On reduction of applications of tacrolimus, a vesicular-pustular rash appeared and was treated with pristinamycin and valaciclovir. At the end of antibiotic and antiviral therapy, the vesicular-pustular rash recurred while the goal was receiving treatment once more with tacrolimus ointment 0.1%. The bacteriological and virological skin samples revealed B-haemolytic streptococcus group A. The negative results for cutaneous virological samples ruled out Kaposi-Juliusberg syndrome and a diagnosis of staphylococcal impetigo was made. The intrinsic imputability of tacrolimus was I3 (C3 S2). DISCUSSION: The most obvious specific feature of this impetigo was its limitation to areas of eczema treated by application of tacrolimus. In prospective studies in large patient cohorts, tacrolimus ointment has been associated with two types of adverse effect: local irritations and skin infections chiefly caused by Staphylococcus aureus. To date, there have been no reports in the literature of impetigo due to haemolytic B streptococcus following application of tacrolimus. Because of its immunodepressant effect, tacrolimus ointment may result in increased incidence of skin infections even though a number of studies have shown a reduction in such infections.

Thought disorder and affective inaccessibility in depression.

In addition to familiar themes of depressive thought content, the authors describe changes in the form of language and thinking in depression which reflect serious disturbances in ego functioning. These disturbances are associated with an inability to express and experience a wide range of affects. The authors suggest that paradoxically, this painful state of affective inaccessibility, rather than an excess of depressive feeling, may be a major component of severe and/or prolonged depression. The evolution of this phase of affective blockade may have important theoretical and clinical treatment implications.

Slow and rapid onset of manic episodes: implications for underlying biology.

The authors describe affectively ill patients with two different patterns of manic onset observed during medication-free periods. One group of patients had rapid onsets in which the full severity of mania was achieved largely by day 1 of a manic episode; a second group had slower onsets, gradually reaching maximal severity of mania later in an episode. Compared to gradual onset patients, those with the rapid onset manic patterns were ill significantly longer, had a greater number of previous depressive episodes, and had more manic and depressive episodes in the year before hospital admission. The clinical and theoretical implications of these data suggesting that patients with a more rapidly cycling and progressive course have an altered pattern of manic onsets are discussed.

Halstead-Reitan Category Test in bipolar and unipolar affective disorders. Relationship to age and phase of illness.

Unipolar and bipolar affectively disturbed patients were administered the Halstead-Reitan category test when in an unmedicated acutely depressed phase and during recovery. Controls consisted of normal volunteers and spouses. Spouse controls were tested at intervals similar to those of the patients and were utilized to control for age, sex, education, and socioeconomic status. Results showed that depressives in the acute depressed state made significantly more errors did controls. Older bipolar patients made significantly more errors than did controls. Older bipolar patients made significantly more errors than younger bipolar or younger unipolar patients. In the recovered state the order remained the same. In spite of a decrease in error scores the older bipolar group remained in the abnormal range, whereas the younger groups scored in the normal range with few exceptions. These data suggest that impaired cognitive functioning may be a factor in the disability associated with the major affective disorders in addition to the distorted affective component usually emphasized. Furthermore, in the case of older bipolar patients, the deficit is more severe and may persist beyond the disappearance of affective signs, suggesting that factors associated with age may play an important role in conjunction with other factors associated with bipolar illness.

Cerebral blood flow in normal pressure hydrocephalus.

A xenon-133 method was used to measure cerebral blood flow (CBF) before and after cerebrospinal fluid (CSF) removal in patients with normal pressure hydrocephalus (NPH). Preliminary results suggested that shunting should be performed on patients whose CBF increased after CSF removal. There was a significant increase in CBF in patients with NPH, which was confirmed by the favorable outcome of 88% of patients shunted. The majority of patients with senile and presenile dementia showed a decrease or no change in CBF after CSF removal. It is suggested that although changes in CBF and clinical symptoms of NPH may have the same cause, i.e., changes in the cerebral intraparenchymal pressure, there is no simple direct relation between these two events. The mechanism underlying the loss of autoregulation observed in NPH is also discussed.