Negative-pressure wound therapy has been shown to be effective in re-epithelialisation in recalcitrant pyoderma gangrenosum. This case documents a patient whose co-morbidities limited the standard treatment options and required an alternative management plan. The STOP GAP randomised control trial found that both oral prednisolone and ciclosporin were equally effective in the treatment of pyoderma gangrenosum. However, in this case, the patient had type 2 diabetes and prednisolone resulted in persistently elevated blood glucose levels. Lower doses were ineffective and it was subsequently stopped once other treatments showed a clinical improvement. A recent diagnosis of breast cancer prevented the use of ciclosporin and other immunosuppressive treatments. After multidisciplinary discussion, involving breast surgeons, oncology, dermatology and tissue viability, doxycycline was commenced alongside a portable negative-pressure device with twice weekly tissue viability input. The introduction of this device resulted in a rapid reduction in the wound size and facilitated healing with an excellent outcome.
Many works of art throughout the centuries have not only garnered intrigue, but also debate among physicians relating to a possible medical diagnosis depicted by the artist. Representation of both anatomy and disease with the use of votive offerings and forms of grotesque art is well recognized. Such work was particularly prevalent in pieces produced during the Hellenistic Age and includes statuettes, anatomical replicas, coins and other art work. Diseases such as acromegaly, Gorlin syndrome, lymphoedema, neurofibromatosis and ophthalmic disorders, among others, have been represented in such pieces. It had been thought by the suppliants that in presenting these offerings to the Gods, particularly Asclepius, the Greek god of medicine and son of Apollo, they could be cured from their ailments. An example of an artistic piece representing an individual with disease is that of a small bronze statuette described as a ‘Statue of an Emaciated Man’ and housed at the Dumbarton Oaks Research Library and Collection, Washington DC. It is a small bronze statue measuring at just 11.5 × 5 × 8.3 cm, and is thought to date from around the first century Bc to the first century Ad. It depicts a gaunt young man sitting atop a bench with his left hand held limply and an apparently swollen right foot. It has been suggested that this individual could have suffered from lead poisoning. However, lead neuropathy is typically symmetrical and emaciation is uncommon. A more common source of lead poisoning in ancient times was wine drinking, as lead was used both as a sweetener and preservative. In addition, occupational exposure was common as lead was used widely in pottery, painting, lead smelting and glass ceramics. A disease that could explain the three features of emaciation, wrist drop and a swollen foot is diabetes mellitus. Diabetes had been recognized in Egyptian manuscripts dating back to 1500 Bc commenting on ‘honey urine’. Diabetes has been well documented during the Hellenistic Age with Apollonius of Memphis in 250 Bc being credited for coining the term ‘diabetes’. Insulin insufficiency can cause emaciation mainly through ketosis. The neuropathy of diabetes mellitus can affect single nerves, and a radial nerve palsy resulting in a wrist drop has been recognized. The appearance of an apparent swollen foot could be due to a Charcot joint, which is a result of repetitive microtrauma-induced complications of polyneuropathy. In conclusion, we believe this statuette represents features consistent with diabetes mellitus and is a ‘bronze diabetic’.
BackgroundSecukinumab was the IL-17 inhibitor licensed for use in Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS). The aim of this study was to evaluate the effectiveness and safety of Secukinumab in our cohort of patients.ObjectivesIn order to assess the effectiveness and safety of Secukinumab, a retrospective analysis of patients treated with this drug in the Northern Health and Social Care Trust was undertaken.MethodsRetrospective data was collected from the Local Biologic database. All patients who were on Secukinumab were selected. They were divided into two arms, Psoriatic Arthritis and Ankylosing Spondylitis. From this baseline disease severity was sought, baseline inflammatory markers and patient cohort data was collected. Patients were seen routinely at three monthly intervals and outcomes were collected up to a 12 month period. From patient notes drug response and adverse effects were recorded.ResultsA total of 41 patients with psoriatic arthritis were treated with Secukinumab over the 12-month period studied. Twenty-six patients were female and fifteen were male, with ages ranging from 26 to 70. Only 12 of the patients were on concomitant methotrexate, all met the NICE start criteria with required DAS 76 scores. Seven of the patients were biologic naïve (17%) at commencement of drug.Of all the patients who responded, most had some response by 3 months, and all had further response by six months.Sixteen patients (39%) discontinued treatment due to no response, one due to increasing shortness of breath, wheeze and rash, and one patient developed colitis.Other side effects were noted, which did not cause the drug to be discontinued. Five patients had rash and urticaria, three reported headaches. Infections were fairly common, five patients had chest infections, four had sinusitis and three had urinary tract infections. Four patients reported thrush, one oral thrush and three vaginal.A total of 18 patients with Ankylosing Spondylitis were commenced on Secukinumab. 11 males and 7 females. A third (6/18) were biologic naïve. Ages ranged from 27 to 65.In the first three months of commencement there was a reduction in BADSAI scores of all patients. This remained at six months. Inflammatory markers CRP and ESR were also reduced.Seven patients discontinued Secukinumab after six months due to side effects or lack or perceived response by the patient (seen in 1 patient). Two patients had a loss of efficacy. The remaining four patients noted cutaneous skin infections, sinus symptoms or headaches as noted in the PsA arm of the audit.ConclusionPatients in the Northern Trust starting Secukinumab generally have severe disease and most have had prior treatment with biologics.There was a high incidence of non responders in this group, however in those patients who responded there was a good response rate at 3 months, and these patients were still on treatment at 12 months. Side effects were as expected, with infections being the most commonly reported side effect.References[1] Robertson J, Tindell A, Crosbie D, ...
Background. Individuals with a prior diagnosis of chronic lymphocytic leukaemia (CLL) have a higher risk of developing melanoma and exhibit poorer outcomes than patients without CLL. However, there are limited data reporting the clinicopathological features of melanoma diagnosed in patients with CLL. Aims. To review clinicopathological characteristics of patients with coexisting diagnoses of melanoma and CLL. Methods. A retrospective review was undertaken for patients with coexisting diagnoses of melanoma and CLL between 2005 and 2015 in 11 centres in the UK and Ireland. Results. Overall, 46 cutaneous melanomas identified in 45 patients were included. In 28 (62.2%) patients, melanoma was diagnosed after an existing diagnosis of CLL. In this group, mean Breslow thickness was 2.7 mm (range 0.2-25 mm). Ten patients (35.7%) developed locoregional recurrence and 8 (28.6%) developed distant metastases. Melanoma-specific mortality was 5 of 28 (17.9%) and all-cause mortality was 13 of 28 (46.4%). In 17 patients, melanoma was diagnosed before CLL. In this group, mean BT was 2.9 mm (range 0.4-14 mm); five patients (29.4%) developed locoregional recurrence and three (17.6%) developed distant metastases. Melanoma-specific mortality was 1 of 17 (5.8%) and all-cause mortality was 5 of 17 (29.4%) in this group. Conclusions. To our knowledge, this is the first and largest cohort study to report clinicopathological data of coexisting melanoma and CLL in the UK and Ireland. Although the thickness of primary melanoma was not different before or after a CLL diagnosis, melanoma recurrence and melanoma-specific mortality appear to be more common in patients with a prior diagnosis of CLL.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.