Exantema fijo medicamentoso por paracetamol. Caso clínico con revisión bibliográfica / Fixed drug eruption with acetaminophen. Clinical case with bibliographic review

El exantema fijo medicamentoso es una toxicodermia caracterizada por la aparición de una lesión cutánea en forma de mácula de color rojizo o violáceo, redonda u oval, edematosa, bien delimitada, y que presenta recurrencias tras la administración del agente causal, generalmente un fármaco. Puede ser producido por una gran variedad de fármacos, entre ellos el paracetamol. El paracetamol es un medicamento con propiedades analgésicas y antipiréticas ampliamente conocido y utilizado por su amplio margen de seguridad y elevada biodisponibilidad. Sin embargo, se han descrito reacciones cutáneas adversas de diferentes tipos e intensidad tras su administración, fundamentalmente urticaria y angioedema, y con menor frecuencia eritema multiforme, necrólisis epidérmica tóxica, exantema fijo y púrpura de Henoch-Schönlein. Se presenta el caso de un usuario tipo con exantema fijo medicamentoso relacionado con el consumo de paracetamol. Se ha realizado una revisión bibliográfica sobre los diversos hallazgos clínicos y el diagnóstico diferencial entre las diferentes toxicodermias, así como el manejo y abordaje de las lesiones basado en el concepto TIME

Fixed drug eruption is a toxicodermia characterized by the appearance of a well-circumscribed reddish or violet, circular or oval, edematous skin lesion which can present recurrences after taking the causal agent, usually a drug. It can be produced by a wide variety of drugs, including acetaminophen. Acetaminophen is a drug with analgesic and antipyretic properties widely known and used for its wide range of safety and high bio-availability. However, different types and intensity of adverse skin reactions have been reported following administration, mainly urticaria and angioedema, and less frequently erythema multiforme, toxic epidermal necrolysis, fixed exanthema and Henoch-Schönlein purpura. We present the case of a role model user with fixed drug exanthema after acetaminophen consumption. A bibliographic review has been made on the various clinical findings and the differential diagnosis between different toxicodermias, as well as the management and approach of the lesions based on the TIME concept

Possible factors influencing the duration of hospital stay in patients with psychiatric disorders attempting suicide by jumping.

BACKGROUND: Patients with psychiatric disorders have a high rate of suicide. The present study investigated factors influencing hospital stays for Japanese patients with psychiatric disorders attempting suicide by jumping. METHODS: We diagnosed all suicide attempts (n = 113) by jumping based on the International Classification of Diseases 10th Revision (ICD-10) and investigated the mean hospital stays of patients with each diagnosis based on the ICD-10 code. We then analyzed differences in the demographic and clinical characteristics between the diagnostic groups to identify factors influencing the duration of hospital stay. RESULTS: Patients diagnosed with schizophrenia (F2 code) were the most frequent (32.7%) of all diagnoses; therefore, we divided the diagnostic groups into schizophrenia group (n = 37) and other psychiatric diagnoses group (n = 76). The patients with schizophrenia showed a significantly longer hospital stay (125.7 ± 63.9 days) compared with the patients with other psychiatric diagnoses (83.6 ± 63.2) (ß ± SE = 42.1 ± 12.7, p = 0.0013), whereas there was no difference in the jump height between the two groups (the average was the 3rd to 4th floor; p > 0.05). The number of injured parts, particularly lower-limb fractures, was significantly higher (p = 0.017) in patients with schizophrenia than in patients with other psychiatric diagnoses. The duration of psychiatric treatment in patients with schizophrenia were significantly longer (z = 3.4, p = 0.001) than in patients with other psychiatric diagnoses. CONCLUSION: Our findings indicate that the number of injuries and the body parts injured in patients with schizophrenia are associated with a longer duration of hospital stay following a suicide attempt by jumping. The current use of antipsychotics and a longer duration of taking antipsychotics might contribute to the risk of bone fracture via hyperprolactinemia. Further cognitive impairment in patients with schizophrenia might prevent rehabilitation for the management of lower-limb fractures. From these results, we suggest that clinicians should monitor the level of prolactin and cognitive function in patients with schizophrenia in future studies on managing of lower-limb fractures.

Perforating foreign body reaction to unheated liquid contents of lava lamp.

A 21-month-old girl developed a local skin reaction after the unheated liquid contents of a broken lava lamp were in contact with her skin overnight. Several weeks later, small umbilicated erythematous papules containing central keratotic spines developed within the affected areas. Biopsy showed a granulomatous foreign body reaction with focal transepidermal elimination. Electron microscopy and energy-dispersive X-ray spectroscopy analysis of the tissue revealed carbon-based material, consistent with substances reported to be present in lava lamp liquid.

Causes of ring-related leg injuries in birds - evidence and recommendations from four field studies.

One of the main techniques for recognizing individuals in avian field research is marking birds with plastic and metal leg rings. However, in some species individuals may react negatively to rings, causing leg injuries and, in extreme cases, the loss of a foot or limb. Here, we report problems that arise from ringing and illustrate solutions based on field data from Brown Thornbills (Acanthiza pusilla) (2 populations), Siberian Jays (Perisoreus infaustus) and Purple-crowned Fairy-wrens (Malurus coronatus). We encountered three problems caused by plastic rings: inflammations triggered by material accumulating under the ring (Purple-crowned Fairy-wrens), contact inflammations as a consequence of plastic rings touching the foot or tibio-tarsal joint (Brown Thornbills), and toes or the foot getting trapped in partly unwrapped flat-band colour rings (Siberian Jays). Metal rings caused two problems: the edges of aluminium rings bent inwards if mounted on top of each other (Brown Thornbills), and too small a ring size led to inflammation (Purple-crowned Fairy-wrens). We overcame these problems by changing the ringing technique (using different ring types or larger rings), or using different adhesive. Additionally, we developed and tested a novel, simple technique of gluing plastic rings onto metal rings in Brown Thornbills. A review of studies reporting ring injuries (N = 23) showed that small birds (<55 g body weight) are more prone to leg infections while larger birds (>35 g) tend to get rings stuck over their feet. We give methodological advice on how these problems can be avoided, and suggest a ringing hazard index to compare the impact of ringing in terms of injury on different bird species. Finally, to facilitate improvements in ringing techniques, we encourage online deposition of information regarding ringing injuries of birds at a website hosted by the European Union for Bird Ringing (EURING).

Caustic ulcers caused by cement aqua: report of a case.

Chromium is widely used in various industries including construction sector. Skin contact with cement has been associated with allergic or irritant contact dermatitis. Contact dermatitis is one of the most frequently reported health problems among construction workers. Irritant contact dermatitis from cement ranges from cement burns to cumulative irritant contact dermatitis. Cement burns are rarely reported and are considered a severe form of acute irritant contact dermatitis. They are associated with amateur user working in a short ready-mix time-frame with poor protective measures. They usually result in significant morbidity and initially are associated with minimal discomfort. We report a typical case.

A wound caused by a small alkaline cell (button battery) under a plaster cast: report of a case.

This is a case report of only the second known instance of an alkaline cell (button battery) causing a wound under a plaster cast.

Not all that glistens is gold: civilian white phosphorus burn injuries.

White phosphorus is an incendiary agent used in particular types of ammunition. Exposure to phosphorus-containing compounds may cause severe burn injuries. Systemic effects may be fatal for the casualty even though only a small surface of the body is burned. We report 4 cases of white phosphorus burn injuries due to an exceptional accident mechanism. All casualties were holidaymakers in a coastal area at the Baltic Sea and confused white phosphorus ammunition residues with amber on a beachwalk. The supposed treasure was taken into the pants pocket. The phosphorus substances ignited spontaneously when they dried because of the body heat. Injury patterns combined simultaneous full thickness burn injuries of both hands with a burn injury of one thigh or the abdominal region. The acute treatment and the controversy surrounding decontamination of such patients are discussed. In addition, pathology of tissue damage and systemic injury are elucidated.

Caustic reaction caused by cement.

A case is reported of a patient who developed full thickness chemical burns of the skin after a prolonged contact while working with wet cement. The history, course of disease, and therapy are described. Cement is an alkaline substance (pH >12) leading to colliquative necrosis. Tissue damage is due to the exothermic reaction of calcium oxide and water forming calcium hydroxide. Patch test was performed to test sensitization to chromium, chromate and cobalt, the usual cement ingredients. In our opinion, such lesions may not be rare because cement is widely used in construction, but are rarely described or under-recognized.

Injury caused by self-inoculation with a vaccine of a Freund's complete adjuvant nature (Gudair) used for control of ovine paratuberculosis.

OBJECTIVE: To document the occurrence and consequences of accidental self-inoculation of vaccinators (producers, farm employees, contractors) with the recently registered Gudair vaccine for the control of ovine paratuberculosis in Australia. DESIGN AND PROCEDURE: A survey of the first 50 primary producers permitted to use the vaccine in sheep and a description of six cases of accidental self-inoculation for which medical attention was sought, and which occurred after the vaccine became widely available. RESULTS: The survey recorded that, of 37 respondents vaccinating 155,523 sheep, there were 21 incidents of exposure to the vaccine, an overall rate of one incident per 7406 vaccinations. In five of these incidents there was only superficial skin contact with vaccine; in 16 there was needle penetration without vaccine injection. There were no reports of self-inoculation with vaccine. Six cases of self-inoculation with Gudair vaccine that required medical intervention are described. Of these five were in males and one in a female; four involved injection of vaccine into the leg and single cases involved a foot or hand. Most cases required surgical removal of the injected vaccine to allow wound repair; three required extensive surgery and open drainage. Even with surgery recovery took as long as 9 months. Possible risk factors for self-inoculation and the resulting outcome are discussed. CONCLUSIONS: Gudair ovine paratuberculosis vaccine can cause prolonged granulomatous inflammation if inadvertently injected into human tissue. After.self-inoculation, early surgical debridement of the damaged tissue and drainage to remove the vaccine material are advised to avoid progression to extensive necrosis.

Psuedoaneurysm of the superficial femoral artery resulting from stingray envenomation.

Stingray envenomations usually result in minor injuries with localized symptoms. In some cases the injury incurred is more serious, resulting in significant morbidity if not adequately treated. We report a case of pseudoaneurysm of the superficial femoral artery resulting from a stingray envenomation in a young female. Stingray venom is known to have necrosing properties in human tissues and in this case this led to graft failure requiring surgical repair. This case emphasizes the insidious nature of stingray venom and the necessity of extensive surgical debridement for more significant envenomations.

Cement burns: a review 1960-2000.

We review the literature on cement burns of the skin published during the last 4 decades. 51 case reports were analyzed with special regard to common modes of injury, localization of cement exposure, preventive measures taken and treatment. Cement burns are injuries concerning professionals at the workplace as well as amateurs during do-it-yourself work. In 49% of the cases, no attempt to protect the skin had been made. The majority of injuries were located on the lower legs and knees. Full-thickness burns were reported in 66% of cases. Surgery had to be performed in 34%. Cement burns can be avoided by adequate skin protection. Although acute cement injuries may seem rare, prospective studies should be carried out for correct estimation of prevalence. The need for information on the harmful properties of cement in the occupational as well as the domestic environment is emphasized.

Wet cement: a poorly recognized cause of full-thickness skin burns.

Cement is a rare cause of full-thickness burns. We have examined the aetiology, frequency and severity of these burns, and assessed public awareness of the potential of cement as a caustic agent. Of patients, 95 per cent were unaware of the potential of cement to cause burns, and none had seen precautionary warnings on cement bags or delivery dockets. Factors important in burn production appear to be alkalinity, duration of contact and the abrasive nature of the cement particles. It is concluded that doctors, especially casualty officers, should know of the potential of progressive full-thickness burns from wet cement. General public awareness should be increased. The cement manufacturers were asked to comment on the content of this paper.

[Treatment of common osteoporosis with fluoride: current trends]. / Traitement de l'ostéoporose commune par le fluor: le point.

The pharmacology of fluoride is reviewed. Efficacy criteria of sodium fluoride in osteoporosis are analysed. An increase in bone mass of the order of 8 per cent per year is seen in 60-70 per cent of osteoporotics whether evaluated by histomorphometry or by bone densitometry in double-blind controlled trials. Fluoride has no effect on bone mass in 30 to 40 per cent of osteoporotics. The reason(s) for such resistance is/are not fully understood. It is not possible at present to state that there is a decrease in the incidence of vertebral fractures on the basis of data from double-blind trials. The incidence of bone fissures affecting the bones of the lower limbs is significantly increased in osteoporotics treated with fluoride, above all if doses of elemental fluoride are greater than 25 mg or in the presence of unrecognised renal insufficiency. The incidence of these fissures is of the order of 20 to 30 per cent.

Death from pool chlorine--an unusual case.

A tank truck containing bulk pool chlorinating solution overturned. A man was trapped beneath the truck, and a ruptured seam in the tank released a continuous flow of sodium hypochlorite over him. He survived for 10 min as the caustic solution extensively eroded soft tissue exposed to the chemical flow.