Familial benign chronic pemphigus. The role of trauma including contact sensitivity.
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A young woman had unilateral dermatomal hyperhidrosis documented by a starch-iodine technique. Evaluation failed to reveal any associated causative conditions. She was treated with 20% aluminum chloride hexahydrate solution in absolute alcohol (Drysol) with a favorable response. With recurrent use, however, she developed miliaria following exertion. Aluminum chloride hexahydrate was shown to be an effective agent to treat this unusual condition, but miliaria with exertion secondary to its use may be a limiting factor.
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OBJECTIVE: To determine the effectiveness of topical corticosteroids in the management of mycosis fungoides. DESIGN: Prospective study. SETTING: Academic referral center, Veterans Affairs Medical Center, and private practice. PATIENTS: Seventy-nine patients with patch or plaque stage of mycosis fungoides. Fifty-one were stage T1 (less than 10% of skin involved) and 28 were stage T2 (10% or more of skin involved). Seventy-five had patch-stage and 4 had plaque-stage disease as determined by histological examination. INTERVENTION: Patients were treated with topical class I to III corticosteroids. Of the stage T1 patients, all used class I corticosteroids, and 4 (8%) also used class II or III corticosteroids. Of the stage T2 patients, 19 (68%) used class I and 12 (43%) used class II or III compounds. Some patients used more than 1 class of corticosteroid. Applications were almost always twice daily. Three stage T1 and 2 stage T2 patients used plastic film occlusion. Baseline and monthly morning serum cortisol levels were obtained during treatment. MAIN OUTCOME MEASURES: Response to treatment and side effects. RESULTS: The median follow-up period was 9 months. Thirty-two (63%) of stage T1 patients achieved complete remission and 16 (31%) achieved partial remission, for a total response rate of 48 (94%). The comparable figures for stage T2 patients were 7 (25%), 16 (57%), and 23 (82%), respectively. Responses were determined by clinical examination. Thirty-nine patients achieved clinical clearing. In 7 of these, posttreatment biopsy specimens were obtained, and all showed histological clearing. Reversible depression of serum cortisol levels occurred in 10 (13%). Minor skin irritation occurred in 2 patients and localized, reversible skin atrophy in 1. CONCLUSION: Topical corticosteroids, especially class I compounds, are an effective treatment for patch-stage mycosis fungoides.
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Three hundred forty children with nonperforating traumatic hyphema were examined to verify or refute the possible protective action of the antifibrinolytic agent, tranexamic acid, against rebleeding. In the retrospective study group, 219 children were treated with strict bed rest, binocular patching, and sedation but did not receive antifibrinolytic agents. In the prospective study group, 121 children received systemically administered tranexamic acid; some of these children were confined to bed rest (26 cases) and some were allowed free ambulation within their rooms (95 cases). In the children who were treated with bed rest but who did not receive the antifibrinolytic agent, the frequency of secondary hemorrhage was 9.6%. Tranexamic acid reduced the incidence of secondary hemorrhage significantly: none of 26 eyes of patients who received systemically administered tranexamic acid and were confined to bed rest rebled, and only one (1.1%) of 95 eyes of children who received tranexamic acid and were allowed free ambulation in the hospital rebled.
An intermittent darkening of the visual field (ganzfeld "blankout") is perceived during bowl perimetry. Since this may be a form of rivalry, we hypothesized that occluding the nontested eye with a translucent occluder may eliminate the phenomenon. Ten normal subjects underwent visual field testing with both a translucent and an opaque occluder. Eight of the 10 reported darkening to occur with the opaque patch, while none reported it with the translucent occluder. The darkening occurred with a mean latency of 10.9 seconds, occupied 34.4% of the time, and on average occurred 3.25 times per minute. With the translucent occluder, retest threshold variability was 18.8% less and sensitivity was increased by 0.7 dB. The elimination of this darkening using translucent occluders in bowl perimetry will allow reduced variability and increased sensitivity and comfort.
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Toxic shock syndrome (TSS) occurs most often in menstruating women who use tampons. It also occurs following surgical procedures. The occurrence of three cases after nasal surgery prompted us to determine the incidence of this complication and to evaluate possible risk factors. Our cases showed that onset of TSS after surgery is rapid. Early symptoms include nausea, vomiting, diarrhea, erythroderma, and hypotension. The wound does not appear grossly infected. Incidence of TSS after nasal surgery during 1980 through 1983 was 16.5 per 100,000, higher than the incidence in women of menstrual age. Splints were used more frequently in patients who developed TSS than in patients who did not. Nasal packing was used in all patients with TSS and in 98% of all patients. Topical or systemic antibiotics did not have a demonstrable protective effect.
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