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Tip: To turn text into a link, highlight the text, then click on a page or file from the list above. Some Important Info You Need to Know About Eczema herpeticumAccording to the British Association of Dermatologists eczema herpeticum is a widespread infection which is potentially serious and can affect people with atopic eczema.
According to DermNet New Zealand, it is a disseminated viral infection which is also known as Kaposi Varicelliform eruption. According the BAD (British Association of Dermatologists), the virus known as Herpes simplex which causes cold sores also causes this type of eczema. According to Consultant 360 for Paediatricians, the condition is associated with an early onset of atopic dermatitis that can be caused by HSV type 1 or type 2 virus. It is very important to check with your doctor or dermatologists immediately because the condition might have developed into a serious infection.
According to British Association of Dermatologist, eczema herpeticum can be cured completely.
As the condition is viral, antiviral treatment is usually prescribed as soon as the condition is diagnosed.
According to the National Institute for Health and Care Excellence (NICE), eczema herpiticum is a serious condition and if not diagnosed promptly may pose serious health problem especailly in case of children. According to the National Center for Biotechnology, if left untreated eczema herpeticum can cause severe infection and even death. According to Medscape, it is a life threatening herpetic super-infection and is a dermatologic emergency. Jaundice, also known as icterus (adjective:"Icteric"), is yellowing of the skin, sclera (the white of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body. When red blood cells die, the heme in their hemoglobin is converted to bilirubin in the spleen and in the kupffer cells in the liver.
Pre-hepatic (or hemolytic) jaundice is caused by anything which causes an increased rate of hemolysis (breakdown of red blood cells). Post-hepatic (or obstructive) jaundice, also called cholestasis, is caused by an interruption to the drainage of bile in the biliary system. The presence of pale stools suggests an obstructive or post-hepatic cause as normal feces get their colour from bile pigments.
Neonatal jaundice is usually harmless: this condition is often seen in infants around the second day after birth, lasting till day 8 in normal births, or to around day 14 in premature births. Objectives.-To explain the mechanism of this artifactual hyperbilirubinemia and to determine its frequency in patients with monoclonal or increased immunoglobulins. Materials and Methods.-The assay was performed manually using serum from 2 index patients and from control patients (without M proteins). Conclusion.-Paraprotein interference with the Roche automated total bilirubin assay is caused by precipitate formation. Monoclonal immunoglobulins (Igs) may interfere with a wide variety of automated nephelometric, turbidimetric, and immunologic assays.1 Their interference with total bilirubin measurements has not been reported. An 88-year-old hypertensive man with multiple myeloma was admitted to our hospital because of a right lower lobe pneumonia. Direct photometric measurements for icterus, lipemia, and hemolysis are performed on the Hitachi 917 by adding sample to saline in a separate cuvette and taking a total of 6 absorbance readings.
Imprecision of the Roche total bilirubin assay was demonstrated by measuring the total bilirubin value several times on the Hitachi 917, using different samples received for the first index patient. We performed a prospective study using serum samples from 100 available, consecutive patients with electrophoretically documented monoclonal gammopathy. Total bilirubin measurements, when repeated several times for our first patient, revealed an imprecise and positive bias (Table 1). The total and direct bilirubin, monoclonal immunoglobulin, and serum creatinine measurements for all patients are shown in Table 2.
We identified 2 patients whose serum paraproteinemia resulted in a spuriously elevated total bilirubin measurement using a Roche assay on the Hitachi 917 automated analyzer. The absence of a solubilizing agent in the direct bilirubin assay strongly suggests that it is this agent that caused the interfering precipitate. Monoclonal immunoglobulins have been shown to interfere with various automated measurements. A customer bulletin received from Roche Diagnostics informed our clinical laboratory that a positive bias may indeed occur with their liquid total bilirubin assay in myeloma patient samples,24 but to date they have provided no explanation or information regarding the frequency of this phenomenon. Whenever high total bilirubin levels are found in patients with plasma cell dyscrasias, Waldenstrom macro-- globulinemia, and possibly lymphomas associated with abnormal immunoglobulin synthesis, in the absence of signs and symptoms of jaundice, the possibility of a spurious hyperbilirubinemia due to an interfering paraprotein should be entertained.
From the Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. It can affect people of all ages both male and female but is more common in infants and children.
The virus sometimes affects a small area but may also spread to quite larger areas of the skin. Furthermore, it needs to be distinguished from dyshidrotic eczema which is very much similar in appearance.
The treatment is orally administered in normal cases whereas in severe cases, the patient may need to be admitted into a hospital for anti-viral treatment through a vein. NICE urges that children who have suspected eczema herpeticum should receive an immediate and urgent treatment.
As we have seen in the above paragraphs, all health organisations and medical experts think it to be a very serious viral infection.
The bilirubin is processed by the liver, enters bile and is eventually excreted through feaces.
Pre-hepatic or hemolytic causes, where too many red blood cells are broken down, hepatic causes where the processing of bilirubin in the liver does not function correctly, and post-hepatic or extrahepatic causes, where the removal of bile is disturbed. Less common causes include primary biliary cirrhosis, Gilbert's syndrome and metastatic carcinoma.
The most common causes are gallstones in the common bile duct and pancreatic cancer in the head of the pancreas.
Serum bilirubin normally drops to a low level without any intervention required: the jaundice is presumably a consequence of metabolic and physiological adjustments after birth.


We describe 2 patients with paraproteinemia and elevated total bilirubin levels measured erroneously using the Roche total bilirubin assay.
This turbidity, rather than the expected color change to pink, increased the absorbance and falsely elevated the total bilirubin value.
We identified 2 patients within a 10-month period who had paraproteins and spuriously elevated total bilirubin levels, when measured using the Roche total bilirubin assay on the Hitachi 917 automated analyzer (Roche Diagnostics, Indianapolis, Ind). He was taking metoprolol tartrate, lisinopril, and also furosemide for congestive cardiac failure.
These samples were identified during the routine interpretation of serum electrophoresis in our clinical laboratory during a 6-month period. When the assay was performed manually, a fine white flocculent precipitate, but no change in color, was noted after both R1 and R2 reagents were added to serum for both the first and second (Figure 1) patients.
No spurious total bilirubin or creatinine measurements using Roche assays on the Hitachi 917 analyzer were detected in any of our patients with monoclonal gammopathy, polyclonal hypergammaglobulinemia, or cryoglobulins. Our first patient with myeloma had a monoclonal IgG-lambda, and our second patient with Waldenstrom macroglobulinemia had a monoclonal IgM-kappa. The turbidity of this suspended precipitate, and not a color change, resulted in increased light absorption when measured spectrophotometrically, which artifactually raised the total bilirubin measurements.
Based on our series of patients with monoclonal gammopathies, the incidence of paraproteins interfering with the Roche total bilirubin assay is very low.
Awareness of this phenomenon may help prevent unnecessary concern and expensive invasive investigations. The institute further emphasises the child should be referred for the same day specialist advice.
It is, therefore, absolutely important to call your doctor urgently or contact your local emergencies services depending upon the country you live in. Certain genetic diseases, such as glucose 6-phosphate dehydrogenase deficiency can lead to increase red cell lysis and therefore hemolytic jaundice. Other causes include strictures of the common bile duct, ductal carcinoma, pancreatitis and pancreatic pseudocysts.
Infants with neonatal jaundice are often treated with bili lights, exposing them to high levels of colored light to break down the bilirubin. A prospective study was then undertaken using serum from 100 consecutive patients with various monoclonal gammopathies and from 13 patients with polyclonal hypergammaglobulinemia and cryoglobulins. Serum from both index patients was anicteric, their direct bilirubin measurements were unaffected, and total bilirubin measured using an alternate assay was normal.
The unexpected hyperbilirubinemia in these patients posed a perplexing problem, as neither patient was jaundiced.
Initial laboratory tests revealed normal values for complete blood count, serum electrolytes, creatinine, and phosphate.
The reaction in this assay requires the sequential addition of 2 liquid reagents (R1 and R2) to the patient's serum sample within the reaction cuvette.
Total bilirubin levels in samples from the index patients were also determined using the Dade Behring Dimension (Newark, Del) clinical chemistry system. To illustrate the phenomenon causing the interference with the total bilirubin measurements, the Roche assay was performed manually for both index patients. An additional 11 individuals who presented during this period with polyclonal hypergammaglobulinemia and 2 with cryoglobulins were also studied. It seems clear from the clinical histories, serum color, direct bilirubin levels, and I index measurements on the Hitachi 917, as well as the total bilirubin values determined using the Dade Behring Dimension instrument, that the Roche total bilirubin levels were falsely elevated and that the most likely cause of the interference was the paraprotein. It is interesting that even with the bichromatic correction used in this assay on the Hitachi 917 the untoward effect of the turbidity is not eliminated.
The method of interference documented in these assays, as was demonstrated in this study, was attributed to the precipitation of the paraprotein, usually in an acid medium. This interference is probably idiosyncratic and is not dependent on either the paraprotein type or concentration. Interference with nephelometric assay of c-reactive protein and anti streptolysin-O by monoclonal lgM-K from a myeloma patient. Pseudohypercreatinemia due to positive interference in enzymatic creatinine measurements caused by monoclonal IgM in patients with Waldenstrom's macroglobulinemia. Interference with the Astra 8 and Synchron CX3 assays of urea nitrogen in serum by a high-Mr inhibitor in a patient with multiple myeloma. Paraprotein interference with colorimetry of phosphate in serum of some patients with multiple myeloma. Inaccurate haemoglobin estimation in Waldenstrom's macroglobulinemia: unusual reaction with monomeric IgM paraprotein. A case of IgG4-lambda type monoclonal immunoglobulin that interfered with determinations for albumin, direct bilirubin and iron in serum [in Japanese].
Abnormal bilirubin binding to human serum albumin in a patient with unusual myeloma immunoglobulin G. Interference of a propranolol metabolite with serum bilirubin estimation in chronic renal failure. This works due to a photo oxidation process occurring on the bilirubin in the subcutaneous tissues of the neonate.
For all patients, serum immunoglobulin (Ig) G, IgA, IgM, total and direct bilirubin, creatinine, and a direct spectrophotometric assessment of icterus were measured. Among the 113 patients studied, no additional spu rious total bilirubin values were detected. If artifactual elevation of total bilirubin is suspected, the laboratory should examine the specimen for icterus (manually or by spectrophotometry) or measure total bilirubin using a different method. We attempted to explain the mechanism of this artifactual hyperbilirubinemia and also to determine the frequency of this phenomenon in patients with monoclonal or increased immunoglobulins. In this assay, after unconjugated bilirubin is solubilized by the addition of a "solubilizing agent," all of the bilirubin is coupled with a diazonium ion in a strongly acid medium (pH 1-2) at 37 deg C to form azobilirubin.2 The color (pink) intensity of the azobilirubin produced is proportional to the total bilirubin concentration. All volumes were accordingly increased in magnitude, while still maintaining the sample-reagent ratios specified by the manufacturer. The precipitate remained stable during warming (37 deg C) and cooling (4 deg C) of the specimen.


Along these lines, one can ascribe the marked imprecision of the Roche total bilirubin values on these samples to the fact that this precipitate likely formed at different times, in varying amounts, and with different particle sizes on each separate occasion. The likelihood of this interference in most of these reports was also unrelated to either the paraprotein type or concentration.
The interference in our 2 index patients occurred with both an IgG-lambda and IgM-kappa paraprotein, and failed to occur in the other 100 patients studied, among whom a wide variety of monoclonal immunoglobulins was exhibited. If you would like further information on a condition, we have supplied links to reliable websites and information and photographs from Dr.
Light energy creates isomerization of the bilirubin and consequently transformation into compounds that the new born can excrete via urine and stools. The absorbance (at 546 nm, with a bichromatic correction at 600 nm) is determined spectrophotometrically. For the first patient's sample, absorbance at a wavelength of 546 run was measured after each step of the assay using a Gilford Stasar III spectrophotometer (Oberlin, Ohio). Any discrepancies between the serum color, I index, and total bilirubin measurements were noted. Only the icteric serum from control patients developed a color (clear pink) change at the end of the assay.
It is ironic that the human eye, but not the Hitachi 917, can easily distinguish the pink color of the genuine diazo reaction from the white turbidity of the precipitate. Only a single report in the Japanese literature noted a human IgG-lambda-type M protein that interfered with the automated determination of direct bilirubin.19 However, paraprotein interference has never before been reported in the literature for total bilirubin measurements. Inspection of the absorbance readings from the total bilirubin assay on the Hitachi 917 revealed that the specimen containing the paraprotein showed increased, but delayed, absorbance when compared with the controls (Figure 2). In contrast, the Hitachi 917 can detect the icterus (or lack thereof) of a serum sample more precisely than the human eye.
Abnormal bilirubin binding to paraproteins can occur in myeloma patients,20 but this reaction has not resulted in falsely elevated total bilirubin levels. Green light is more effective at breaking down bilirubin, but is not commonly used because it makes the babies appear sickly, which is disturbing to observers.
Clinically, the patient was not jaundiced, and there was no supporting evidence for hemolysis or liver disease.
Unfortunately, it cannot use the discrepancy between the I index and the measured total bilirubin to alert the operator to the problem under discussion. Interference with the measurement of total bilirubin due to propranolol with certain automated diazo techniques has been documented.21-23 Our 2 index patients had not been on propranolol therapy, and none of the drugs being taken by these patients, including rituximab, have been reported to erroneously affect bilirubin values. Blackheads, whiteheads, pimples, and even deeper lumps such as cysts or nodules can occur on the face, neck, chest, back, shoulders, and upper arms. All incubations were timed as in the automated assay and performed in a 37 deg C water bath.
Serum protein electrophoresis and immunofixation electrophoresis revealed a monoclonal IgG-lambda M protein. The absorbance data for these samples from the total bilirubin assay on the Hitachi 917 were retrieved. Attempts to redissolve the precipitate from the macroscale reaction mixture of the second index patient were unsuccessful, precluding further analyses of the precipitate. Many different types of cysts exist but the most common type is the epidermal (sebaceous) cyst.
This condition is caused by an altered immune system response to many factors and is often associated with other allergy related conditions. Approximately 10-20% of the world population is affected by this chronic, relapsing, and very itchy rash at some point during childhood.
Causes range from hormonal disorders, medical problems, hereditary disorders, medications, nutritional problems and hair cosmetic treatments. Lesions tend to recur and effective oral medications are available to help treat this condition.A  A  MelanomaOf all skin cancers, melanoma is the most serious.
It is a cancer of the pigment-producing cells in the skin and can spread to other parts of the body. Springtime is the most common time of the year to get poison ivy when the urge to have a pretty yard hits. It most commonly occurs on the elbows, knees and trunk, but can appear anywhere on the body.
It is a chronic condition that cycles through flare-ups and remissions throughout the patient’s life. Common forms of fungus infections of the skin include athletea€™s foot, jock itch and ringworm of the scalp, body or nails.
The proper treatment regimen is very important to follow in order to cure this problem.ScabiesSeborrheic KeratosesThese are noncancerous (benign) skin growths that some people develop as they age.
They often appear on the back or chest but are also common on the scalp, face, arms, and legs. After someone gets chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. They frequently appear in skin folds of the armpits, neck and groin.They are also calledA acrochordons. It is characterized by white, pink or tan scaly spots usually located on the neck and upper body. Treatment involves antifungal washes and occasionally oral medications.Tinea Versicolor A VitiligoVitiligo is a medical condition that causes the skin to lose color. Vitiligo can develop on any part of the body but commonly begins on hands, forearms, feet, or the face. Sometimes they look flat and smooth; other times they have a dome-shaped or cauliflower-like appearance. They occur in people of all ages and can spread from person-to-person and from one part of the body to another.



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