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Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction with few large cohorts reported. This multicenter retrospective study included patients with SJS/TEN seen by inpatient consultative dermatologists at 18 academic medical centers in the United States. A total of 377 adult patients with SJS/TEN between January 1, 2000 and June 1, 2015 were entered, including 260 of 377 (69%) from 2010 onward. The most frequent cause of SJS/TEN was medication reaction in 338 of 377 (89.7%), most often to trimethoprim/sulfamethoxazole (89/338; 26.3%). Most patients were managed in an intensive care (100/368; 27.2%) or burn unit (151/368; 41.0%). Most received pharmacologic therapy (266/376; 70.7%) versus supportive care alone (110/376; 29.3%)-typically corticosteroids (113/266; 42.5%), intravenous immunoglobulin (94/266; 35.3%), or both therapies (54/266; 20.3%). Based on day 1 SCORTEN predicted mortality, approximately 78 in-hospital deaths were expected (77.7/368; 21%), but the observed mortality of 54 patients (54/368; 14.7%) was significantly lower (standardized mortality ratio = 0.70; 95% confidence interval = 0.58-0.79). Stratified by therapy received, the standardized mortality ratio was lowest among those receiving both steroids and intravenous immunoglobulin (standardized mortality ratio = 0.52; 95% confidence interval 0.21-0.79). This large cohort provides contemporary information regarding US patients with SJS/TEN. Mortality, although substantial, was significantly lower than predicted. Although the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and intravenous immunoglobulin, among other therapies, may warrant further study., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Ethical issues commonly arise in inpatient dermatology consultations. We describe the case of an inpatient suffering from a severe, undiagnosable skin condition that raises key principles of medical ethics. The four principles include autonomy, nonmaleficence, beneficence, and justice. Ethical situations faced by inpatient dermatologists are similar to those experienced by medicine hospitalists, as compared with outpatient dermatologists, given the unique clinical setting in which inpatient dermatology is practiced. Other inpatient services, colleagues, and ethics committees are useful resources for inpatient dermatologists faced with difficult ethical situations., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This report reviews the experience of the Santa Clara County Maternal Mortality Study Committee, which continued its local activity after the termination of California state-supported study groups in 1970. A study of 36 maternal deaths among approximately 262,000 live births was compiled over a 13-year period, between 1971 and 1983, in a population group representative of much of California. Although based on a small population sample, the results indicate an imperative need for such reviews to improve the quality of clinical care and to develop significant statistical information on the incidence and causes of maternal mortality. The historical development of study committees throughout the United States illustrates the necessity of standardized definitions and uniform methodology among study groups in all states and territories. A nationwide study is proposed to obtain a broad-based, cumulative maternal mortality series, directed toward the eventual elimination of preventable maternal deaths. The current effort by a special interest group in the American College of Obstetricians and Gynecologists is commended for beginning this task.

The authors present three cases of extensive squamous cell carcinoma of the conjunctiva invading the orbit and masquerading as orbital cellulitis. All cases were in elderly alcoholic men living in relative social isolation. Total exenteration of the orbit was required in all three cases. Only one patient has had long-term follow-up; he was well 5 years after presentation. The other two patients were well 15 and 5 months after surgery.