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In clinical practice, the attention given to sexual problems in patients with end-stage renal disease is low. In order to evaluate the erectile function in chronic renal failure patients undergoing hemodialysis (HD) as a renal replacement therapy in upper Egypt, we used the abridged version of the International Index of Erectile Function (IIEF-5). In all, 75 HD patients were subjected to clinical and laboratory investigations. The controls were 948 healthy males representing the general Egyptian population. The prevalence of erectile dysfunction (ED) among the HD patients was 82.5% compared to 30% among controls. The prevalence of ED in HD group was significantly higher than in controls. The prevalence of ED in HD patients o50 y was 80% and it was 88% in those Z50 y, while the prevalence of ED among controls was 28 and 69.8%, respectively. The prevalence of severe degree of ED was significantly higher in both groups compared to controls, while moderate degree of ED showed a statistical significance compared to controls in age groups o50 y and mild degree of ED showed a statistical significance compared to controls in age groups Z50 y. The univariate logistic regression analysis showed that age (r ¼ À0.3368, Po0.01), serum urea (r ¼ À0.5974, Po0.001), and creatinine level (r ¼ À0.5804, Po0.001) have a significant negative correlation with the presence of ED among HD patients, while serum hemoglobin (r ¼ 0.3396, Po0.001) and years of HD age (r ¼ 0.3147, Po0.01) have a significant positive correlation with the presence of ED among the HD patients. In view of the observed high prevalence of ED among the HD patients, we believe that a complete health evaluation of male HD patients should include a discussion about erectile function in the standard clinical care program of patients with renal disease.

Oxidative stress was observed in both tissues and blood of MB patients and in tissues of PB patients, denoting its crucial involvement in the pathogenesis of leprosy. This can constitute an important tool in prognosis, treatment and control of leprosy.

Based on these results, the relation between H. pylori and AA is not supported. We advise that H. pylori detection should not be included in the laboratory workup of AA.

Hisham Zayan Abdel-Hafez, MD, has indicated no significant interest with commercial supporters. C utaneous metastases of pancreatic carcinoma is a rare phenomenon. The most common site of cutaneous metastasis is the umbilicus, which is known as Sister Joseph's nodule. There are scant reports of pancreatic cutaneous metastasis at nonumbilical areas. After reviewing the published literature on this phenomenon by conducting a detailed PubMed search, 16 cases of pancreatic carcinoma with cutaneous metastasis at sites other than the umbilical area were identified. This is a report on a new case of advanced pancreatic carcinoma with cutaneous metastases on the neck. This case represents a scenario that validates that nonumbilical cutaneous pancreatic metastases arise secondary to primary pancreatic cancer located at the head of pancreas. Case ReportA 55-year-old woman was referred to our department with skin lesions that had appeared 3 weeks before on her left neck. On physical examination, there were asymptomatic violaceous nodules and indurated plaques; the remainder of the examination was normal.The patient was admitted to the Oncology Department because of jaundice and general fatigue accompanied by multiple enlarged, firm, nontender left cervical lymph nodes. Routine laboratory testing showed high total and direct bilirubin and high liver enzymes, whereas renal and hepatitis marker tests were within normal ranges. Chest and bone roentgenograms showed no pathological findings. Abdominal ultrasound visualized a mass located at the head of the pancreas measuring 4.6 Â 4.8 cm with multiple enlarged porta hepatis lymph nodes and evidence of dilated intrahepatic biliary radicals and common bile duct. Consequently she was referred for a computed tomography (CT) scan of the abdomen, which revealed enlarged head of the pancreas with a heterogeneous soft tissue mass measuring 5 Â 5 cm with multiple porta hepatis and para-aortic lymph node enlargement with no evidence of hepatic focal lesions. Examination and thorough investigation did not detect metastases elsewhere.Abdominal ultrasound and CT findings were compatible with cancer of the head of pancreas with multiple metastatic abdominal lymph nodes causing common bile duct obstruction. Surgical abdominal exploration revealed a large mass at the head of the pancreas, cholecystojejunostomy and enteroenterostomy were done, but the surgeons did not take a biopsy from the unresectable mass for fear that it would be complicated by a pancreatic fistula.The patient was referred for an evaluation by a dermatologist for skin lesions at the left side of the neck that appeared 3 weeks after starting palliative chemotherapy. Skin and lymph node biopsy were done. Histopathological examination of the lymph nodes revealed metastatic carcinoma, and that of the skin revealed nests of poorly differentiated atypical cells throughout the dermis (Figure 1). Silver stain and chromogranin were negative, whereas epithelial

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