Background. Assessment methods for atopic dermatitis (AD) are not standardized, and therapeutic studies are difficult to interpret. Aims. To obtain a consensus on assessment methods in AD and to use a statistical method to develop a composite severity index.Methods. Consensus definitions were given for items used in the scoring system (extent, intensity, subjective) and illustrated for intensity items. Slides were reviewed to address within and between-observer variability by a group of 10 trained clinicians, and data were statistically evaluated with a two way analysis of variance. Two variants of an assessment system were compared in 88 patients at 5 different institutions. Data were analyzed using principal-component analysis. Results. For 5 intensity items studied (erythema, edema/papulation, oozing/crusts, excoriations, lichenification), within- and between-observer variability was good overall, except for edema/papulation which was difficult to assess with slides. In the series of 88 patients, principal-component analysis allowed to extract two unrelated components: the first one accounting for 33% of total variance was interpreted as a ‘severity’ component; the second one, accounting for 18% of variance, was interpreted as a ‘profile’ component distinguishing patients with mostly erythema and subjective symptoms and those with mostly lichenification and dryness and lower subjective symptoms. Of the two evaluation systems used, the one using the rule of nine to assess extent was found more workable than the one using a distribution × intensity product. A scoring index (SCORAD) combining extent, severity and subjective symptoms was mathematically derived from the first system and showed a normal distribution of the population studied. Conclusion. The final choice for the evaluation system was mostly made based on simplicity and easy routine use in outpatient clinics. Based on mathematical appreciation of weights of the items used in the assessment of AD, extent and subjective symptoms account for around 20% each of the total score, intensity items representing 60%. The so-designed composite index SCORAD needs to be further tested in clinical trials.
Electrocardiographic patterns typical of hypopotassemia and compatible with hypopotassemia were defined on the basis of the number of electrocardiographic signs of hypopotassemia present in 2 leads (generally leads II and V3). In 50 hypopotassemic patients a good correlation was found between the electrocardiographic pattern and plasma potassium concentration. Appearance of the electrocardiographic signs of hypopotassemia was not prevented by disturbance of other plasma electrolytes or by blood pH. LLECTROCARDIOGRAMS of patientswith low concentrations of extracellular potassium frequently show characteristic abnormalities that disappear after administration of potassium salts.1' 2 Regression of the electrocardiographic pattern of hypopotassemia during administration of potassium is characterized by a gradual increase of T-wave amplitude, decrease of U-wave amplitude, and diminution of S-T segment depression in the standard limb and precordial leads without any change in Q-T or other components of the Q-U interval.' This sequence of regression suggests that the converse, the evolution of the hypopotassemia pattern, consists of a progressive decrease of T-wave amplitude, increase of U-wave amplitude, and S-T segment depression in the standard limb and precordial leads. Accordingly, a schematic construction of 5 patterns, representing 5 stages in the evolution of the electrocardiogram in hypopotassemia, has been made.' At that time no During the past fewl years we have gained an impression that in a majority of patients with hypopotassemia, electrocardiograms can be correlated with the concentration of extracellular potassium. However, since others3-7 have failed to find a correlation between the electrocardiogram and serum potassium level, it was thought that a new investigation might be helpful. We made an attempt to develop quantitative criteria for objective evaluation of the electrocardiographic changes ill these patients. We also considered certain factors other than the potassium concentration that, may influence the electrocardiogram of patients with hypopotassemia.This paper presents the results of the correlation between the electrocardiogram and plasma potassium level in 50 patients with hypopotassemia. METHODS ANXI) MATERIALFifty adult patients with plasma potassium levels below 3.5 mEq./L. were selected for the study.
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