RESUMO
BACKGROUND: Jaundice is a marker of advanced disease and poor outcomes in hepatocellular carcinoma (HCC). The aim of this study was to describe and analyse the management and outcomes of jaundiced HCC patients at a large academic referral centre in sub-Saharan Africa (SSA). METHODS: Treatment-naïve adult HCC patients who presented with jaundice between 1990 and 2023 were analysed. RESULTS: During the inclusion period, 676 HCC patients were treated at Groote Schuur Hospital. The mean age of the 126 (18.6%) who were jaundiced was 48.8 (± 13.2) years. Eighty-nine (70.6%) were male. Ninety-four (74.6%) patients with jaundice secondary to diffuse tumour infiltration had best supportive care (BSC) only. Thirty-two had obstructive jaundice (OJ); four were excluded because of missing hospital records. In 28 of these patients, 16 underwent biliary drainage (BD) and 12 received BSC only. The mean overall survival (OS) of the 126 patients was 100.5 (± 242.3) days. The patients with diffuse tumour infiltration had an OS of 105.9 (± 273.3) days. The patients with OJ survived 86.5 (± 135.0) days. There was no significant difference in OS between the three patient groups (p = 0.941). In the OJ group, patients who underwent BD survived longer than the BSC group (117.9 ± 166.4 vs. 29.2 ± 34.7 days, p = 0.015).
Assuntos
Carcinoma Hepatocelular , Icterícia Obstrutiva , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Masculino , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patologia , Feminino , Pessoa de Meia-Idade , África Subsaariana/epidemiologia , Adulto , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/terapia , Estudos Retrospectivos , Icterícia/etiologia , Taxa de Sobrevida , Resultado do Tratamento , IdosoRESUMO
Dermatomyositis (DM) is an autoimmune connective tissue disease that is included in the idiopathic inflammatory myopathies. Cutaneous manifestations are a prominent part of the condition: some skin signs in DM are common to most patients, while other signs are encountered infrequently. A number of features are pathognomic for DM. The demonstration of myositis-specific antibodies (MSAs) in DM has extended the ability to define phenotypic subgroups. It appears that the presence of certain MSAs confers susceptibility to specific clinical features, an association which reveals a serotype-phenotype relationship. In this review article we have provided a detailed summary of common and under-recognized cutaneous manifestations of DM.
Assuntos
Dermatomiosite/patologia , Exantema/patologia , Calcinose/etiologia , Dermatomiosite/complicações , Dermatoses Faciais/patologia , Dermatoses da Mão/patologia , Humanos , Dermatoses da Perna/patologia , Paniculite/etiologia , Dermatoses do Couro Cabeludo/patologia , Tronco/patologiaAssuntos
Infecções por Coronavirus/diagnóstico , Dermatologistas/organização & administração , Hospitais Urbanos/organização & administração , Admissão e Escalonamento de Pessoal , Pneumonia Viral/diagnóstico , Encaminhamento e Consulta/organização & administração , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , COVID-19 , Competência Clínica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Humanos , Londres/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Papel Profissional , SARS-CoV-2RESUMO
Contrast media (CM) are an indispensable part of modern medical imaging. Adverse reactions to CM are uncommon, but frequently involve cutaneous symptoms. This two-part article reviews adverse events secondary to CM that are relevant to the practising dermatologist. Part 1 covers the classification of CM, immediate hypersensitivity reactions to CM and the newly described condition, gadolinium deposition disease. Given that there has only been two case reports to our knowledge of a delayed adverse reaction to gadolinium-based CM, this second part will focus on cutaneous delayed reactions caused by iodinated CM (ICM). Delayed hypersensitivity reactions to ICM commonly present as maculopapular exanthems, but more rarely, they can manifest as fixed drug eruptions, acute generalized exanthematous pustulosis, drug-related eosinophilia and systemic symptoms, Stevens-Johnson syndrome/toxic epidermal necrolysis, symmetrical drug-related intertriginous and flexural exanthema, graft-versus-host disease, vasculitis and iododerma. Delayed reactions to ICM may be underdiagnosed, as cutaneous symptoms may be attributed to oral medications, particularly if patients are on multiple drugs.
Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade Tardia/induzido quimicamente , Iodo/efeitos adversos , Dermatopatias/induzido quimicamente , Pustulose Exantematosa Aguda Generalizada/etiologia , Idoso , Exantema/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias/patologia , Síndrome de Stevens-Johnson/etiologiaRESUMO
Contrast media (CM) are commonly used worldwide to enhance the quality of imaging, which is invaluable for diagnostic accuracy. Adverse reactions to CM are uncommon, but frequently involve cutaneous symptoms. This two-part article reviews adverse events secondary to CM that are relevant to the practising dermatologist. Part 1 will classify CM, address immediate hypersensitivity reactions and review the newly described condition, gadolinium deposition disease. Part 2 will cover the delayed hypersensitivity reactions of iodinated contrast medium including severe cutaneous adverse reactions and iododerma.
Assuntos
Meios de Contraste/efeitos adversos , Gadolínio/efeitos adversos , Hipersensibilidade Imediata/induzido quimicamente , Dermatopatias/induzido quimicamente , Meios de Contraste/farmacocinética , Gadolínio/farmacocinética , Humanos , Distribuição TecidualRESUMO
During the Second World War, thousands of captured British and Commonwealth troops were interned in prisoner-of-war (POW) camps in the Far East. Imprisonment was extremely harsh, and prisoners developed multiple pathologies induced by physical hardship, tropical infections and starvation. Immediately after the war, several POW doctors published their clinical experiences, including reports of skin disease caused by malnutrition. The most notable deficiency dermatoses seen in Far East POWs were ariboflavinosis (vitamin B2 or riboflavin deficiency) and pellagra (vitamin B3 or niacin deficiency). A lack of vitamin B2 produces a striking inflammatory disorder of scrotal skin. Reports of pellagra in POWs documented a novel widespread eruption, developing into exfoliative dermatitis, in addition to the usual photosensitive dermatosis. A review of the literature from 70 years ago provides a reminder of the skin's response to malnutrition.
Assuntos
Desnutrição/história , Pelagra/história , Prisioneiros/história , Deficiência de Riboflavina/história , Dermatopatias/história , II Guerra Mundial , Ásia Oriental , História do Século XX , Humanos , Masculino , Desnutrição/complicações , Pelagra/patologia , Deficiência de Riboflavina/patologia , Escroto/patologia , Dermatopatias/etiologia , Reino UnidoAssuntos
Antibacterianos/efeitos adversos , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/cirurgia , Cefalexina/efeitos adversos , Transplante de Fígado , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/terapia , Feminino , Humanos , Testes de Função Hepática , Pessoa de Meia-Idade , Síndrome , Infecções Urinárias/tratamento farmacológicoAssuntos
Dermatologia/estatística & dados numéricos , Toxidermias/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Substituição de Medicamentos , Feminino , Hospitalização/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Londres , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse reactions to drugs that cause a life-threatening eruption of mucocutaneous blistering and epithelial sloughing. While the acute complications of SJS/TEN are well described, it is increasingly recognized that survivors may develop delayed sequelae, some of which can be associated with significant morbidity. Studies of long-term SJS/TEN outcomes mostly focus on mucocutaneous and ocular complications. However, other internal organs, such as the respiratory tract and gastrointestinal tract, can be affected. Psychological sequelae are also frequent following the trauma of widespread epidermal necrolysis. An appreciation of the 'chronic' phase of SJS/TEN is needed by clinicians caring for individuals who have survived the acute illness. This review aims to provide an update on the breadth and range of sequelae that can affect patients in the months and years following an acute episode of SJS/TEN.