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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The more common paraneoplastic skin changes associated with internal malignancies (acanthosis nigricans, dermatomyositis, secondary ichthyosis) are discussed. The rare glucagonoma syndrome, consisting of alpha cell tumor of the pancreas, migratory necrolytic erythema, and diabetes mellitus, is described. The importance of recognition of these skin lesions may lead to early detection of the underlying cancer with possible cure.
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PMID:Cutaneous signs of internal malignancies. 684 28

Phagedena is an old term for serious deep, necrotic and gangrenous skin ulcers. In the past these have been regarded as severe infections. A review of 31 cases revealed that except in cases of Streptococcus pyogenes or Clostridium welchii infection a bacterial of fungal infection was only one of several factors that led to the development of phagedenic ulcers. Initiating factors may be a bacterial infection, a debilitated state as a result of immunosuppressive therapy or of such conditions as alcoholism, severe diabetes, inflammatory bowel disease or severe arteriosclerosis, and various types of injury or trauma. Continuing factors include enzymatic mechanisms, the release of toxins from large areas of dead tissue and vascular disorders. In general, antibiotics are of limited value. systemic corticosteroid therapy may be useful in the subacute or chronic case. In acute, spreading, gangrenous phagedena with surrounding erythema, fever and systemic toxic effects, immediate excision of dead tissue may be lifesaving.
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PMID:Phagedena: gangrenous and necrotic ulcerations of skin and subcutaneous tissue. 706 92

Vascular spiders, palmar erythema and Dupuytren's contracture had been studied in four groups of patients with alcoholic cirrhosis, hepatic alcoholic involvement without cirrhosis, alcoholism without hepatic involvement, extrahepatic diseases without alcoholism. these cutaneous lesions had been observed more frequently in alcoholic cirrhosis, with an incidence of 72%, 38%, 24% respectively. Vascular spiders, palmar erythema and Dupuytren's contracture appeared related to the hepatic involvement from alcoholism rather than to the alcoholism by oneself. In the alcoholic cirrhosis the Dupuytren's contracture affected patients younger than those of the others groups and had been influenced from the association of diabetes mellitus, but not from the occupational activity.
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PMID:[Vascular spiders, palmar erythema and Dupuytren's contracture in alcoholic hepatic cirrhosis. Clinical-statistical contribution]. 722 58

The authors report the case of a 22-year-old Guatemalan in whom lupus was diagnosed 8 months after a second pregnancy. The diagnosis of lupus met the criteria of the ARA: Raynaud's syndrome, alopecia, arthralgia, thrombophlebitis, facial erythema, antinuclear factor at 1/100, Farr at 75 p. 100 and immunofluorescent demonstration of IgM binding in healthy skin. Two months after the beginning of the lupus, there was onset of insulin-resistant ketosic diabetes without overweight. The serum insulin was 1.140 mu U/ml. Acanthosis nigricans was noted and confirmed by a biopsy. Insulin-resistance can be attributed to anti-membrane receptor antibodies titrating at 1/200 (R. Khan). The short-term progress of the disease was favorable on corticosteroid treatment. Insulin could be stopped, but high insulin serum levels persisted. This case meets criteria for type B as defined by Flier, Khan and Roth, and is the first European case of lupus with a complete presentation. Short-term progress was favorable, and there is no evidence to affirm that there will be a tardive progression towards hypoglycemia which is, however, possible due to the persistence of elevated serum insulin levels.
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PMID:[Lupus, insulin-resistant diabetes and acanthosis nigricans (author's transl)]. 723 1

Over a period of eight years, 247 unselected patients with more or less widespread areas of obvious cutaneous erythema on the lower legs and/or feet (incipient gangrene) or corresponding areas with cutaneous necrosis (manifest gangrene) were examined at our department. Of these patients, 34% had incipient and 66% manifest gangrene. It was found that 75% had open diabetes; the other were classified as non-open diabetics. In 75% of the 247 patients these lesions accompanied cardiac decompensation with or without edema, edema of other causes or--in some cases--arterial insufficiency. The gangrene developed in most patients a short time after the onset of these precipitating factors. Arterial insufficiency alone or together with other precipitating factors was seen considerably less often. Edema was thus the main precipitating factor for these lesions. Cardiac decompensation as well as edema of the legs due to other causes respond well to treatment. When treating such patients with open or nonopen diabetes, it should be taken into consideration that gangrene is a serious condition.
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PMID:Gangrene localized to the lower limbs in diabetics. 744 9

Necrobiosis lipoidica of the legs, in which deep ulcers resembling erythema induratum, gummas or a variety of other chronic progressive ulcerating skin diseases occur, is described. In 2 cases the lesions were precipitated by a crush injury elsewhere in the same leg, but not at the site of the ultimate lesions. In 2 further pairs of siblings the same problem arose as a familial complaint without trauma. These cases were distinguished by severe necrosis in the absence of diabetes.
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PMID:Non-diabetic necrobiosis lipoidica. Hitherto unrecognized papulonecrotic, nodulo-ulcerative and familial forms of the disease. 746 84

Since their initial description in 1957, the interferons (IFNs) have been increasingly used to treat a wide array of diseases. Acute adverse effects, i.e. 'flu-like' syndromes, hypo- or hypertension, tachycardia, headache, myalgias and gastrointestinal disorders, occur within the first hour or day after starting treatment. They are seldom treatment-limiting and are easily manageable. Sub-acute and chronic effects develop after several days, usually within 2 and 4 weeks of therapy. The most typical is neurological toxicity, including fatigue/asthenia, and behavioural and cognitive changes. Such symptoms may seriously impair quality of life and result in treatment discontinuation. Seizures have seldom been described. Other infrequent central nervous system adverse effects include vertigo, cramp and oculomotor nerve paralysis. Distal paraesthesias and peripheral neuropathy have been reported. IFN-associated autoimmunity is quite rare but a matter of concern. Biological or clinical manifestations usually require several months to become apparent. Autoantibodies have been shown to develop in most patients but have been inconsistently associated with clinical symptoms of systemic lupus erythematosus, rheumatoid-like arthritis and thyroiditis. Both hypo- and hyperthyroidism have been described but are usually reversible. Other infrequent autoimmune reactions include diabetes, pemphigus and worsening of multiple sclerosis. Although several patients present with a pre-existing autoimmune disorder, no predisposing factor has been clearly established. While hypotension and tachycardia are the most frequent acute cardiovascular complications, a few additional cases of cardiac arrhythmias and myocardial ischaemia have been reported after a short course or several weeks of treatment. These latter complications do not appear to be dose-dependent or age-related. Isolated cases of congestive heart failure have also been described. Mild proteinuria has been observed in 15 to 25% of patients, but acute renal toxicity is uncommon. A transient rise in serum aminotransferase levels is frequently noted during the first stage of therapy, especially in patients receiving the highest dosages. Direct hepatotoxicity is extremely rare. Autoimmune hepatitis, which is ill-diagnosed as chronic viral hepatitis, and de novo induction of autoimmune hepatitis, account for the majority of liver diseases. Haematotoxicity is relatively common but mild to moderate, and develops gradually during the first weeks of treatment. Neutropenia is the most common haematological toxicity, but is usually not dose-limiting and resolves rapidly upon drug discontinuation. Myelosuppression, autoimmune and immune allergic haemolytic anaemias and thrombocytopenias have seldom been described. Cutaneous adverse effects comprised nonspecific erythema and hair loss and, less frequently, vasculitis, local ulcerations at the site of injection and exacerbation of psoriasis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical toxicity of the interferons. 751 63

Glucagonoma Syndrome is a rare syndrome comprising hyperglucagonemia, diabetes mellitus, necrolytic migratory erythema and hypoaminoacidemia in the setting of a glucagon producing, alpha cell tumour of the pancreas. We report a case of Glucagonoma Syndrome palliatively treated successfully with octreotide. In addition to classical clinical and biochemical findings, this patient also had a Glomus Jugulare tumour, and Empty Sella Syndrome and demonstrated an unusual pattern of plasma lactate dehydrogenase isoenzymes, features not previously reported in this syndrome.
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PMID:Glucagonoma syndrome with increased lactate dehydrogenase isoenzymes: octreotide treatment. 752 1

Glucagonoma is a rare pancreatic tumor, necrolytic migratory erythema is its distinctive feature and it is often associated with diabetes mellitus, weight loss, anemia, hypoaminoacidemia, glossitis and stomatitis. We reported a case of glucagonoma misdiagnosed as "eczema" and "benign hepatic anginoma" for 3 years. His blood glucagon level was 1,758 ng/L. The results of abdominal B-mode ultrasonography and CT scan were negative, but selected arteriogram showed a tumor mass between the pancreatic body and tail. Before operation, treatment with octreotide and supply of amino acids were given with improvement of the skin lesion. After resection of the tumor from pancreas, necrolytic migratory erythema disapeared, but his blood level of glucagon and amino acids did not improve. It is suggested that any diabetic patient with chronic skin damage should be checked for blood glucagon level. In suspected cases, selected arteriogram will be helpful for location of the tumor. Vigorous resection of the pancreatic tumor should be done as soon as possible, even though there is already metastases.
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PMID:[Report of a case of glucagonoma misdiagnosed as "eczema" and "hepatic angioma" for three years and review of literature]. 764 42

We report two cases with severe skin reactions following oral terbinafine (Lamisil) therapy. The first case was a 49-year-old woman with onychomycosis of the toe nails. She had suffered from diabetes for 3 years, but it was well controlled on insulin. Five days after start of terbinafine 250 mg once daily she developed erythema. The treatment was continued for 2 days, but the skin eruption progressed, and a clinical diagnosis of toxic epidermal necrolysis was confirmed histologically. The second case was a 51-year-old woman with dermatomycosis on the right foot. She developed a papular eruption in the second week after taking terbinafine 250 mg once daily. Despite this eruption she continued treatment for 6 days. Generalized erythema multiforme developed in the following days. Terbinafine is a recently introduced efficacious fungicidal drug. This is the first report of toxic epidermal necrolysis following terbinafine.
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PMID:Toxic epidermal necrolysis and erythema multiforme following therapy with terbinafine. 781 81


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