Identifying and managing arterial ulceration.
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Inflammation of the skin in the immediate neighborhood of a stoma (peristomal dermatitis) occurs--at least temporarily--in about two-thirds of all stoma patients. The often apparently uniform clinical presentation may conceal a variety of different pathological conditions, a knowledge of which is a must for the correct diagnosis and therapeutic strategy, which in turn is essential to prevent the development of a vicious circle of dermatitis and stomal insufficiency, which in the worst case may make a surgical intervention necessary.
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This review discusses the more common cutaneous disorders associated with internal malignancy. Some rare but specific entities are included, and some recently recognized associations are highlighted. Particular emphasis is given to the key physical signs, which can alert the physician to the possibility of underlying neoplastic disease.
Behcet's disease (BD) is characterized by a great geographic diversity of clinico-evolutive features. We identify the main clinical characteristics in our series as compared to other data in international literature. We studied 36 patients (16 women and 20 men) with BD fulfilling International Study Group for Behcet's Disease (ISGBD) criteria. We recorded the clinical features and compared the data with other recent statistics. The incidence of clinical manifestations in our group was the following: oral ulcerations -97.4%, genital ulcerations - 55.5%, vascular disease - 50%, antiphospholipid antibodies - 55%, digestive tract lesions - 28.5%, eye disease - 27.7%, pulmonary disease - 8.3%, arthritis - 5.4%, CNS lesions - 2.7%. The clinical course was generally mild. Our patients had a higher incidence of vasculo-thrombotic events, of APLAs and of oral aphthosis, as compared to other statistics. Eye disease, CNS, articular involvement and pathergy were encountered rarer than in other groups. Two cases had atypical onsets: one with a pyoderma gangrenosum-like lesion and the other with severe pulmonary hypertension. BD has protean clinical aspects, with important geographic particularities. Our patients ran a relatively mild course of the disease, more like the Western European than the Asian patients. Vasculothrombotic disease was an important feature, with a subsequent risk for mortality.
Surgical indication for ulcerative colitis is fulminant colitis, intractability, cancer or dysplasia. New surgical indication should be established because new medical treatment such as leucocytoapheresis or intravenous cyclosporine treatment developed. Standard surgical procedure is ileal pouch anal anastomosis with rectal mucosal stripping and stapled ileal pouch anal anastomosis. Postoperative bowel function and QOL are satisfactory in both of them. Surgical treatment should be performed without any delay for the patients who do not respond medical treatment.
Extraintestinal complications of patients with ulcerative colitis contribute to quality of life and mortality of the patients. Extraintestinal complications involve many organ systems. Skin, mucocutaneous, hepatobiliary, and joints complications are major extraintestinal complications. Some disorders correspond the activity of the colitis, other complications develop independently of the bowel inflammation. The purpose of this review is to update the clinicians concerning the etiology, clinical course and the therapy of the extraintestinal manifestations associated with ulcerative colitis.
BACKGROUND: While most patients who present with a rash have no associated systemic illness, many systemic illnesses have skin manifestations at some stage. OBJECTIVE: This article uses case vignettes to illustrate a problem oriented approach to five commonly presented skin conditions that have common and varied systemic associations. A logical sequence of management for each case is provided. DISCUSSION: Often the skin manifestations of systemic disease are vague and nonspecific such as the toxic erythema that might follow a viral infection or a drug eruption. Sometimes it is the systemic manifestations that are vague and nonspecific, while the skin manifestations are highly specific and define the illness. There is currently no useful classification for cutaneous manifestations of systemic disease.
An unusual clinical appearance and course of pyoderma gangraenosum (PG) in a 35-year-old woman is presented. Signs of both the ulcerative and vegetative forms of PG were expressed. The association of two systemic diseases, the autoimmune thyreopathy and the hyperandrogenic syndrome were observed in a female. The recommended conventional therapy for PG: corticosteroids, antibiotics, cyclosporine and cyclophosphamide yielded a poor response, whereas after thyroidectomy and reaching an euthyroid state the symptoms receded. This close association of PG and autoimmune thyreopathy supports the autoimmune concept of PG.
The authors present a case of 61-year-old man with ulcerative colitis and with extraintestinal manifestation of the disease in the form of pyoderma gangraenosum. Multiple skin defects, which developed in atypical localisation (extensive affection of facial and hairy parts of the head) in patient with chronically active form of ulcerative colitis were complicated with bacterial contamination of methicilin-resistant strains of Staphylococcus aureus. After application of the parenteral feeding, corticotherapy and targeted antibiotic therapy the subjective and objective status of the patient markedly improved, stool frequency was reduced, admixture of blood in the stool disappeared, temperatures fell back and there was a decrease in activity of non-specific bowel inflammation in laboratory findings. However endoscopic examination of the intestine confirmed the finding of chronically active ulcerative colitis with ulcerations and bridging polyps. Patient was indicated to total colectomy, but he refused it.
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