Post-traumatic stress disorder in Stevens-Johnson syndrome and toxic epidermal necrolysis: prevalence and risk factors. A prospective study of 31 patients.

BACKGROUND: Epidermal necrolysis is a rare and severe cutaneous adverse reaction to drugs with long-term somatic consequences and potentially underrecognized psychological complications. OBJECTIVES: To assess the prevalence and risk factors of post-traumatic stress disorder (PTSD) in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a population of adults undergoing psychiatric evaluation. METHODS: In this prospective study, we included adult patients admitted at the acute phase of SJS/TEN to our dermatology department from June 2009 to February 2013. The main objective was to assess the prevalence of PTSD at 6 months after the acute disease phase, defined by a PTSD Checklist score > 44. Secondary objectives were to investigate risk factors of PTSD in the medical history of patients and characteristics of the disease at the acute phase by the Peritraumatic Dissociative Experience Questionnaire (PDEQ) and Peritraumatic Distress Inventory (PDI) and the degree of impairment on the Sheehan Disability Scale. RESULTS: We initially included 32 of 80 patients admitted during the study period. At 6 months, seven of 30 still followed up had a PTSD Checklist score > 44, suggesting a PTSD prevalence of 23%; 23 (77%) patients had a hydroxyzine prescription at the acute phase. The main risk factors associated with PTSD at 6 months were psychological results at the acute phase. CONCLUSIONS: Despite frequent prescription of hydroxyzine at the acute phase, almost one-quarter of patients with SJS/TEN had PTSD at 6 months. A systematic psychiatric evaluation should be offered regularly for at least 1 year after the acute disease phase.

Ultrastructural studies of the effect of human leukocyte extracts on periodontopathic bacteria.

Human gingival crevicular exudate (GE) and leukocyte extracts (LE) were previously shown to be able to release the bulk of radioactivity from a variety of 14C-labeled oral bacteria. The present study demonstrates that the release of radiolabel by these enzymatic agents from two periodontopathic bacteria (Actinobacillus actinomycetemcomitans strain Y4 and Capnocytophaga sputigena strain 4) is accompanied by both cell wall and cytoplasmatic damage. The possible role of bacterial products released by lysosomal enzymes, present in the gingival crevice, is discussed.

[Hepatosplenic candidiasis in acute myeloid leukemia]. / Candidiasis hepatoesplénica en un paciente con leucemia mieloide aguda.

Chronic diseminated candidiasis--mainly its hepatosplenic form- is one of the most characteristic invasive infection due to Candida in haematological patients. A case is presented of a 31 year old man admitted to the Clinical Department with acute mieloid leukosis M2, showing febrile neutropenia after induction and consolidation chemotherapy. Hepatoesplenic candidiasis was diagnosed and confirmed by computered axial tomography (CAT) and hepatic biopsy; amphotericin B followed by liposome encapsuled amphotericin B up to complete a total dose of 4 g was used for treatment. The patient was discharged waiting for bone marrow transplantation. Early suspicion of hepatosplenic candidiasis helps to select a rapid diagnosis method and an effective treatment.

[Stress tests in old age. The choice of the stress protocol]. / Provas de esforço na terceira idade. Escolha do protocolo de esforço.

OBJECTIVE: To evaluate, in an elderly Portuguese population, the diagnostic capacities of the most popular treadmill stress test protocols. DESIGN: Retrospective study of an elderly Portuguese population submitted to a stress test. PATIENTS AND METHODS: A population of 45 patients (35 male), aged 65 or more years, consecutively submitted to a stress test. The average age of the group was 67.8 +/- 2.9 years. The three protocols (Bruce, Bruce Modified and Naughton) were comparatively studied in terms of the patients capacity to execute the protocol, capacity to obtain a maximum and a diagnostic stress test, and the complications of the stress test protocol. MAIN RESULTS: The Bruce protocol was used in 19 patients, the Bruce Modified in 13 patients and the Naughton protocol in 13 patients. The three protocols did not lead to any complication. The Bruce protocol led to a larger increment in heart rate (p < 0.001) and to larger maximum rate pressure product (p < 0.05) than the Naughton one. The Bruce protocol obtained a larger number of diagnostic tests (p < 0.01) and a significantly lower number of inconclusive stress tests. The Naughton protocol led to a larger duration of the exercise tests and was not suitable for some of the elderly patients owing to the exhaustion of the protocol. The results obtained with the Bruce Modified protocol were among those of other two protocols. CONCLUSIONS: In the elderly, the stress tests are safe and useful in the diagnosis of exercise induced ischemia and in the stratification of cardiovascular risk. From the protocols studied, the Bruce protocol was the most adequate, globally speaking, for this group of patients. The Bruce protocol presented a better diagnostic capacity with no complications related to the protocol.

[Announce a death rapes to the close relations in emergency situation and taken care]. / Annoncer une mort violente aux proches en situation d'urgence extrahospitalière et les accompagner.

The death is a part of the everyday life of the emergency medical teams, but to announce the death and to take care in immediate of the saddened close relations rest a testing experience for which the professionals of the emergency care are not still prepared. Our comment aims from the experience of care of families, saddened in immediate and also recorded within the framework of a specialized consultation, to pass on what the saddened persons can feel during the intervention of the help and the confrontation in the death of their close. Our objective being to bring to the professionals of the tracks of reflection to limit the risks of survictimisation.

[The announcement of a serious diagnosis]. / L'annonce d'un diagnostic grave.

The diagnosis of an illness or a serious handicap is a traumatic event for the patient. Beyond the shock generated by the disease or the handicap, the conditions surrounding the announcement have a determining impact on the reactions of the patient and the course of care. The announcement of the diagnosis can reduce or reinforce the shock. This article analyses the psychological risks which underlie the announcement of a serious diagnosis. The traumatic impact of a serious diagnosis, the possible reactions of and the psychological consequences for the patient are described. Recommendations regarding an announcement plan are proposed. Finally, the possible follow-up for the patients as well as for the caretakers are discussed.

Leishmania major and L. donovani: effects on proteolytic enzymes of Phlebotomus papatasi (Diptera, Psychodidae).

Phlebotomus papatasi is susceptible to Leishmania major which it transmits in nature, but is resistant to L. donovani. The present study compares the effect of L. major and L. donovani on the proteolytic activity of P. papatasi gut enzymes. The experiments measured digestion of C14-labeled globin by gut homogenates of flies. Homogenates were prepared from flies fed on serum only (controls) or from flies fed serum containing promastigotes or their dried culture overlayer. In other experiments, the promastigotes or dried culture overlayers were added in vitro to the gut homogenate of control flies. Proteolytic activity of gut homogenate from flies infected with L. major was about one-third less than that of controls, while that from flies infected with L. donovani was one-third greater. Ingestion of L. major dried culture overlayer had an effect on flies similar to that of the promastigotes, while L. donovani dried culture overlayer produced no significant effect. When added to gut homogenate in vitro, promastigotes of both species promoted proteolysis as did dried culture overlayer of L. major. Dried culture overlayer of L. donovani, however, had an opposite effect. It is suggested that the observed reduction in proteolytic activity caused by L. major infection may result from inhibition of enzyme production.

[Experience of health personnel at an organ procurement center]. / Vécu des personnels dans un centre de prélèvement d'organes.

Organs' procurement oblige to take care of a great number of brain death patients. This study concerns the psychological influence of such a situation on teams, nurses and physicians of this specific activity of harvesting. It took place in three organs' procurement intensive care units and interested sixty three men and women. These teams reveal the difficulty to live "the brain death", according to brain death patients themselves and their families, but also to transplantation: to work on brain death patients for the life of other patients. So it seem necessary to give a place at a psychologist in this specific intensive care units not for the patients, they are dead, but for the teams.

Candidiasis hepatoesplénica en un paciente con leucemia mieloide aguda / [Hepatosplenic candidiasis in acute myeloid leukemia]

Chronic diseminated candidiasis--mainly its hepatosplenic form- is one of the most characteristic invasive infection due to Candida in haematological patients. A case is presented of a 31 year old man admitted to the Clinical Department with acute mieloid leukosis M2, showing febrile neutropenia after induction and consolidation chemotherapy. Hepatoesplenic candidiasis was diagnosed and confirmed by computered axial tomography (CAT) and hepatic biopsy; amphotericin B followed by liposome encapsuled amphotericin B up to complete a total dose of 4 g was used for treatment. The patient was discharged waiting for bone marrow transplantation. Early suspicion of hepatosplenic candidiasis helps to select a rapid diagnosis method and an effective treatment.

Estudio comparativo de los pediculos intrahepaticos en las piezas de hepatectomias por cancer del higado. / Comparative study of the intrahepatic pedunculus in surgical pieces in hepatectomies by liver neoplasms

Se investigo un grupo de controles sin tumor hepatico y otro con las vias de diseminacion de las neoplasias primarias (hepatomas) y secundarias del higado (metastasis de origen vesicular y colonico) en piezas de 8 pacientes operados. Los autores senalan la gran importancia que tiene el estudio histopatologico intraoperatorio por congelacion y diferido de las piezas