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Artecoll® is a recently developed permanent synthetic cosmetic filler substance, composed of 80% bovine collagen and 20% polymethylacrylate (PMMA) microspheres of 32–40 μm in diameter. It is used for the augmentation of deep wrinkles and is to be injected subdermally. We report the development of granulomas at the site of Artecoll injections in the face in a 48-year-old woman who had pulmonary sarcoidosis. There were features consistent of both sarcoid and foreign-body granuloma, typical of those reported previously with Artecoll. We postulate that the PMMA foreign material contained within Artecoll acted as a stimulus for the development of the cutaneous sarcoid granulomas. [ABSTRACT FROM AUTHOR]

Toxic epidermal necrolysis (TEN) is a rare severe reaction of the skin resulting in full thickness damage to the epidermis. The condition has significant morbidity as a result of dehydration, protein loss, thermoregulatory difficulties, and renal, lung, liver and heart failure. The mortality rate approaches 30%, most commonly from bacterial sepsis. Management of this condition is cessation of the suspected causative agent and supportive care on a burns or intensive care unit. There have been recent reports of treatment using intravenous immunoglobulin (IVIG) therapy, though its efficacy is yet to be established. It has been proposed that IVIG inhibits the Fas-FasL mediated apoptosis of keratinocytes affected by TEN. We describe a case of extensive drug-induced TEN in a 33-year-old woman who showed rapid improvement with IVIG therapy at a dose of 0.75 g/kg/day given for four consecutive days.

Objective: To determine how prepared operating departments are to manage latex-allergic patients, and particularly urologists, because the highest incidence of latex allergy occurs in patients with spina bifida who undergo frequent urological procedures., Methods: A standard questionnaire about the provision of latex-free equipment within operating theatres was completed by the 72 hospitals surveyed (33 district general, 27 teaching, six children's and six private hospitals)., Results: Anaesthetic latex-free equipment was available in five of the children's hospitals, 56% of the teaching hospitals, 45% of the district general hospitals and two of the private hospitals. A latex-free catheter only was provided in two of the children's hospitals, 30% of the teaching hospitals and 12% of the district general hospitals. In addition, one of the children's hospitals and one of the private hospitals had a comprehensive range of urological latex-free equipment available., Conclusion: This survey shows that many hospitals are inadequately prepared to manage latex-allergic patients, because they lack anaesthetic and urological latex-free equipment.

A year after the Department of Health issued guidelines on post exposure prophylaxis (PEP) for health care workers exposed to HIV, we conducted a telephone survey of occupational health nurses and junior doctors in London teaching hospitals, to assess implementation of the guidelines and awareness among junior doctors of local policies. The management and administration of PEP for HIV differed considerably between hospitals. Many junior doctors did not know what to do in the event of a needlestick injury. Both the implementation of and the briefing of staff about current management policies need to improve.