[Photopheresis: an alternative therapeutic approach in corticoresistant erosive oral lichen planus]. / La photophérèse: une alternative thérapeutique aux corticoïdes pour le lichen érosif muqueux corticorésistant.

BACKGROUND: The immunomodulatory effect of extracorporeal photochemotherapy (photopheresis) coupled with its efficacy in lymphocytic skin diseases provides a rationale for its use for erosive lichen planus. We report two cases of chronic oral erosive and corticoresistant lichen planus successfully treated with photopheresis. PATIENTS AND METHODS: Case 1. A 61-years-old man had erosive oral lichen planus for four years. Oral steroids were contra-indicated due to iatrogenic pancreatitis. After nine photopheresis sessions, subjective improvement occurred and the oral lesions were stabilized. Case 2. A 17-years-old woman presented corticodependent oral and genital erosive lichen planus and cutaneous lesions. After seven sessions of photopheresis, the patient was able to eat again and the pain decreased. After 20 sessions, the cutaneous lichen planus disappeared and complete remission of the mucous lesions was obtained without corticotherapy. DISCUSSION: These two cases, together with 23 other cases reported elsewhere, strongly suggested the value of photopheresis in the treatment of erosive lichen planus. However, relapses after treatment withdrawal appear extremely frequent.

Alternative method of funding hospital capital expenditures.

This article presents a model that demonstrates how a hospital can form a strategic partnership with a vendor to use the vendor's previous knowledge, experience, and strategic alliances to fund capital expenditures and implement cost savings programs for the hospital, with no capital outlay or risk to the hospital. The vendor assumes full financial risk for the success of the program. In exchange for the vendor's full risk, the hospital shares in the savings with the vendor.

Antibiotic prophylaxis in elective genitourinary tract surgery: a comparison of single-dose pre-operative cefotaxime and multiple-dose cefoxitin.

In a randomized, single-blind study, the efficacy of single-dose cefotaxime was compared with multiple dose cefoxitin in genitourinary surgery prophylaxis. Patients received either 1.0 g cefotaxime before surgery; or 2.0 g cefoxitin pre-operatively and every 8 h for no more than 24 h post-operatively. Of the evaluable patients receiving cefotaxime 3 of 35 (8.6%) became infected post-operatively, compared to 12 of 37 (32.4%) patients receiving cefoxitin (P less than 0.01). It is concluded that single-dose genitourinary surgical prophylaxis with cefotaxime may be more effective than a longer dosing schedule with cefoxitin in the prevention of post-operative urinary tract infections, and that a single-dose regimen may represent significant cost containment advantages for hospitals.