Confluent and reticulated papillomatosis (CRP) is a rare skin disorder. To dat e its aetiology remains uncertain. The possibility of an infectious aetiology ha s been supported by case reports of therapeutic response ...Confluent and reticulated papillomatosis (CRP) is a rare skin disorder. To dat e its aetiology remains uncertain. The possibility of an infectious aetiology ha s been supported by case reports of therapeutic response to antibiotic therapy. We have isolated and identified a previously unknown Dietzia strain, an Actinomy cete, from skin scrapings of a 17-year-old boy with CRP. We propose that this organism may be the aetiological agent of CRP. Further investigations are necess ary to determine the potential role of this Actinomycete in the pathogenesis of CRP.展开更多
BACKGROUND:Colonic gallstone is an uncommon entity with high morbidity and mortality due to various reasons. It remains a diagnostic challenge because of delayed and non-specific presentations,especially in the elderl...BACKGROUND:Colonic gallstone is an uncommon entity with high morbidity and mortality due to various reasons. It remains a diagnostic challenge because of delayed and non-specific presentations,especially in the elderly population,often with multiple co-morbidities. METHOD:We present a case of 81-year-old woman who had a large bowel obstruction due to colonic gallstone. RESULTS:Immediately after a cholecysto-colonic fistula was found by laporotomy,she underwent a single stage enterolithotomy,cholecystectomy and fistula closure. CONCLUSIONS:A single stage enterolithotomy,cholecys- tectomy and fistula closure is ideal for this condition. Various other surgical options in the literature are discussed.展开更多
Background: Sudan is experiencing a growing cancer problem. Esophageal cancer (EC) is a devastating disease with high mortality. Our objective was to study the demographic factors and histopathological pattern of EC c...Background: Sudan is experiencing a growing cancer problem. Esophageal cancer (EC) is a devastating disease with high mortality. Our objective was to study the demographic factors and histopathological pattern of EC cancer in Khartoum, Sudan. Methods: In a retrospective cross-sectional study, the records and histopathology reports of all patients diagnosed endoscopically as EC and who were referred to Zain center, a reference histopathology center in Khartoum Sudan, were studied over a 6-month period. Descriptive and simple statistics were used for analysis. Results: Out of 74 histopathologically studied patients, 66 (89.2%) had squamous cell (SCC) cancer (average age 59 y, mainly females) and 8 (10.8%) had adenocarcinoma (AC-average age 69 y). The female to male ratio is 1.5:1. In females with SCC, the tumors mainly located in the upper and middle thirds of the oesophagus. On the other hand, 6 out of the 8 patients with AC were men, with the tumors located mainly in the lower third. Conclusions: In Khartoum, Sudan, esophageal cancer affects females (predominantlySCC) more than males (predominantly AC). It occurs at a relatively young age, and is predominantly squamous cell in type. No specific risk factors were identified and this needs further studies.展开更多
Background: Digital myxoid cysts (DMC) are often unsightly; theymay cause nail dystrophy and are sometimes painful. There is a multitude of existing therapies and recurrences are not uncommon; some treatments may be p...Background: Digital myxoid cysts (DMC) are often unsightly; theymay cause nail dystrophy and are sometimes painful. There is a multitude of existing therapies and recurrences are not uncommon; some treatments may be painful or result in scarring. Infrared coagulation (IRC) produces predictable thermal injury with relative sparing of superficial tissues and represents an alternative treatment modality in DMC. Objectives: To assess the outcome of treatment of DMC with IRC. Methods: Twenty- two patients with DMC treated with IRC were identified retrospectively (23 DMC: 18 finger and five toe). IRC was delivered to the area of the cyst under local anaesthesia. Results: Of the 23 lesions treated with IRC 86% responded; these included 73% that resolved after a single treatment, one lesion that relapsed after 3 years, one lesion that was reduced in size and one lesion that required three treatments over 18 months but has not recurred over the subsequent 9 years. There were three early recurrences that required treatment with other modalities: two were successfully treated with surgery and one responded to a single treatment with cryo- therapy. One patient was excluded from the analysis because it was not possible to assess her adequately. Conclusions: We present long- term follow- up data (mean follow- up 4.8 years, range 10 months- 10.5 years) of the treatment of DMC with IRC. Treatment was well tolerated, with few side- effects, and cosmetic outcomewas excellent. While recurrence rates were similar to many existing therapies, the ease of delivery, tolerability and cosmetic results make IRC a favourable option for the treatment of DMC.展开更多
Pyoderma gangrenosum (PG) is associated with a number of systemic diseases. PG in association with hidradenitis suppurativa (HS) has been rarely reported. We describe six patients (three men, three women; aged 35- 51 ...Pyoderma gangrenosum (PG) is associated with a number of systemic diseases. PG in association with hidradenitis suppurativa (HS) has been rarely reported. We describe six patients (three men, three women; aged 35- 51 years),who developed PG on a background of HS. The onset of PG occurred only after HS had been present for at least two decades. No relationship in disease activity between the two conditions was observed. Three patients described previous severe adolescent acne vulgaris, one had concurrent systemic lupus erythematosus and another had chronic iron- deficiency anaemia. The course of PG was severe and refractory in four patients,who required treatment including high- dose oral corticosteroids, ciclosporin, intravenous immunoglobulin and intravenous cyclophosphamide.展开更多
The frequency of orthostatic hypotension (OH) in cohorts of patients recruited through hospital Parkinsons disease (PD) clinics ranges from 16%to 58%. How ever, hospital based cohorts may be subject to ascertainment...The frequency of orthostatic hypotension (OH) in cohorts of patients recruited through hospital Parkinsons disease (PD) clinics ranges from 16%to 58%. How ever, hospital based cohorts may be subject to ascertainment bias. The aim of th is study was to determine the frequency of OH in a community based population of PD patients and to determine the demographic features of patients with and with out OH. Forty two (47%) of patients met the criteria for OH. Subjects with OH w ere older than those without OH, but there was no difference in PD disease durat ion or severity, MMSE or depression rating between the groups.展开更多
Ba ckground Pulmonary arterial systolic pressure (PASP) can be estimated with transthoracic echocardiography. However, the significance of raised PASP on routine echocardiography is uncertain. In this study, we evalua...Ba ckground Pulmonary arterial systolic pressure (PASP) can be estimated with transthoracic echocardiography. However, the significance of raised PASP on routine echocardiography is uncertain. In this study, we evaluated the mortality and hospitalization rates of subjects with raised PASP in a cohort of patients referred directly by their general practitioners for routine outpatient (open access) echocardiography for further analysis of suspected heart failure. Results A total of 485 subjects were referred for open access echocardiography at our hospital in 2002. A cohort of 209/485 (43%) consecutive subjects with measurable tricuspid regurgitation were followed for a minimum of five years investigating hospitalization rates and survival. Some 62 of 209 (30%) subjects had pulmonary hypertension (PH). Subjects with PH were significantly more likely to have four or more hospital admissions (22% vs. 8%; P < 0.01) and > 30 days of cumulative hospital stay over five years (29% vs. 13%; P < 0.01). PH was significantly associated with mortality (P = 0.003), while moderate to severe PHwas an independent predictor of mortality (hazard ratio: 4.31; 95% confidence interval (95% CI): 1.51–12.30). Records from the Office of National Statistics revealed that subjects with PH were more likely to have chronic lung diseases recorded as immediate or contributory causes of death (50% vs. 14%; P < 0.05). Conclusions PASP ≥36 mmHg on routine echocardiography is associated with recurrent hospital admissions, prolonged hospitalizations and increased cause of mortality. Therefore, the diagnosis of PHon echocardiography deserves further clinical evaluation, with future studies designed at defining a suitable diagnostic strategy.展开更多
文摘Confluent and reticulated papillomatosis (CRP) is a rare skin disorder. To dat e its aetiology remains uncertain. The possibility of an infectious aetiology ha s been supported by case reports of therapeutic response to antibiotic therapy. We have isolated and identified a previously unknown Dietzia strain, an Actinomy cete, from skin scrapings of a 17-year-old boy with CRP. We propose that this organism may be the aetiological agent of CRP. Further investigations are necess ary to determine the potential role of this Actinomycete in the pathogenesis of CRP.
文摘BACKGROUND:Colonic gallstone is an uncommon entity with high morbidity and mortality due to various reasons. It remains a diagnostic challenge because of delayed and non-specific presentations,especially in the elderly population,often with multiple co-morbidities. METHOD:We present a case of 81-year-old woman who had a large bowel obstruction due to colonic gallstone. RESULTS:Immediately after a cholecysto-colonic fistula was found by laporotomy,she underwent a single stage enterolithotomy,cholecystectomy and fistula closure. CONCLUSIONS:A single stage enterolithotomy,cholecys- tectomy and fistula closure is ideal for this condition. Various other surgical options in the literature are discussed.
文摘Background: Sudan is experiencing a growing cancer problem. Esophageal cancer (EC) is a devastating disease with high mortality. Our objective was to study the demographic factors and histopathological pattern of EC cancer in Khartoum, Sudan. Methods: In a retrospective cross-sectional study, the records and histopathology reports of all patients diagnosed endoscopically as EC and who were referred to Zain center, a reference histopathology center in Khartoum Sudan, were studied over a 6-month period. Descriptive and simple statistics were used for analysis. Results: Out of 74 histopathologically studied patients, 66 (89.2%) had squamous cell (SCC) cancer (average age 59 y, mainly females) and 8 (10.8%) had adenocarcinoma (AC-average age 69 y). The female to male ratio is 1.5:1. In females with SCC, the tumors mainly located in the upper and middle thirds of the oesophagus. On the other hand, 6 out of the 8 patients with AC were men, with the tumors located mainly in the lower third. Conclusions: In Khartoum, Sudan, esophageal cancer affects females (predominantlySCC) more than males (predominantly AC). It occurs at a relatively young age, and is predominantly squamous cell in type. No specific risk factors were identified and this needs further studies.
文摘Background: Digital myxoid cysts (DMC) are often unsightly; theymay cause nail dystrophy and are sometimes painful. There is a multitude of existing therapies and recurrences are not uncommon; some treatments may be painful or result in scarring. Infrared coagulation (IRC) produces predictable thermal injury with relative sparing of superficial tissues and represents an alternative treatment modality in DMC. Objectives: To assess the outcome of treatment of DMC with IRC. Methods: Twenty- two patients with DMC treated with IRC were identified retrospectively (23 DMC: 18 finger and five toe). IRC was delivered to the area of the cyst under local anaesthesia. Results: Of the 23 lesions treated with IRC 86% responded; these included 73% that resolved after a single treatment, one lesion that relapsed after 3 years, one lesion that was reduced in size and one lesion that required three treatments over 18 months but has not recurred over the subsequent 9 years. There were three early recurrences that required treatment with other modalities: two were successfully treated with surgery and one responded to a single treatment with cryo- therapy. One patient was excluded from the analysis because it was not possible to assess her adequately. Conclusions: We present long- term follow- up data (mean follow- up 4.8 years, range 10 months- 10.5 years) of the treatment of DMC with IRC. Treatment was well tolerated, with few side- effects, and cosmetic outcomewas excellent. While recurrence rates were similar to many existing therapies, the ease of delivery, tolerability and cosmetic results make IRC a favourable option for the treatment of DMC.
文摘Pyoderma gangrenosum (PG) is associated with a number of systemic diseases. PG in association with hidradenitis suppurativa (HS) has been rarely reported. We describe six patients (three men, three women; aged 35- 51 years),who developed PG on a background of HS. The onset of PG occurred only after HS had been present for at least two decades. No relationship in disease activity between the two conditions was observed. Three patients described previous severe adolescent acne vulgaris, one had concurrent systemic lupus erythematosus and another had chronic iron- deficiency anaemia. The course of PG was severe and refractory in four patients,who required treatment including high- dose oral corticosteroids, ciclosporin, intravenous immunoglobulin and intravenous cyclophosphamide.
文摘The frequency of orthostatic hypotension (OH) in cohorts of patients recruited through hospital Parkinsons disease (PD) clinics ranges from 16%to 58%. How ever, hospital based cohorts may be subject to ascertainment bias. The aim of th is study was to determine the frequency of OH in a community based population of PD patients and to determine the demographic features of patients with and with out OH. Forty two (47%) of patients met the criteria for OH. Subjects with OH w ere older than those without OH, but there was no difference in PD disease durat ion or severity, MMSE or depression rating between the groups.
文摘Ba ckground Pulmonary arterial systolic pressure (PASP) can be estimated with transthoracic echocardiography. However, the significance of raised PASP on routine echocardiography is uncertain. In this study, we evaluated the mortality and hospitalization rates of subjects with raised PASP in a cohort of patients referred directly by their general practitioners for routine outpatient (open access) echocardiography for further analysis of suspected heart failure. Results A total of 485 subjects were referred for open access echocardiography at our hospital in 2002. A cohort of 209/485 (43%) consecutive subjects with measurable tricuspid regurgitation were followed for a minimum of five years investigating hospitalization rates and survival. Some 62 of 209 (30%) subjects had pulmonary hypertension (PH). Subjects with PH were significantly more likely to have four or more hospital admissions (22% vs. 8%; P < 0.01) and > 30 days of cumulative hospital stay over five years (29% vs. 13%; P < 0.01). PH was significantly associated with mortality (P = 0.003), while moderate to severe PHwas an independent predictor of mortality (hazard ratio: 4.31; 95% confidence interval (95% CI): 1.51–12.30). Records from the Office of National Statistics revealed that subjects with PH were more likely to have chronic lung diseases recorded as immediate or contributory causes of death (50% vs. 14%; P < 0.05). Conclusions PASP ≥36 mmHg on routine echocardiography is associated with recurrent hospital admissions, prolonged hospitalizations and increased cause of mortality. Therefore, the diagnosis of PHon echocardiography deserves further clinical evaluation, with future studies designed at defining a suitable diagnostic strategy.
