Journal of the American Academy of Dermatology
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J. Am. Acad. Dermatol. · Oct 2011
Characteristic purpura of the ears, vasculitis, and neutropenia--a potential public health epidemic associated with levamisole-adulterated cocaine.
Dermatologists at the University of California, San Francisco recently reported two patients in the online Journal of the American Academy of Dermatology with purpura presumably induced by levamisole in contaminated cocaine. Levamisole-induced vasculitis and neutropenia has been reported elsewhere in the United States and Canada. Up to 70% of cocaine in the United States could be contaminated. ⋯ It appears the use of cocaine is associated with the peculiar clinical findings of ear purpura, retiform purpura of the trunk, and neutropenia. We believe this case series may represent the tip of the iceberg as a looming public health problem caused by levamisole. Although the direct causal relationship may be difficult to establish, the astute dermatologist or primary care physician should be able to recognize the characteristic skin lesions and should be wary of the potential development of agranulocytosis.
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J. Am. Acad. Dermatol. · Oct 2011
Outcome of 6 years of protocol use for preventing wrong site office surgery.
Patient safety is emerging as an integral part of the overall strategy to improve health care in the United States. Wrong site surgery is correctly noted to be a sentinel event and great efforts must be made to avoid it. ⋯ Integration of a correct surgery site protocol into a daily patient care model is a useful step in preventing occurrences of wrong site dermatologic surgery.
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J. Am. Acad. Dermatol. · Oct 2011
Brachioradial pruritus as a result of cervical spine pathology: the results of a magnetic resonance tomography study.
Brachioradial pruritus (BRP) describes a rare form of itching occurring at the dorsolateral part of the forearms. Recent case reports suggest that BRP may be attributed to cervical lesions or spine neoplasms. ⋯ BRP may result from cervical nerve compression, and rarely, it may also stem from degenerative changes. Our findings suggest that even slight cervical changes detected on MRT may alter itch afferents and lead to BRP. Spinal cord tumors are rare and should be ruled out by a cervical spine MRT.