Helicobacter pylori-positive patients with pruritic skin diseases are at increased risk for gastric cancer.

BACKGROUND: Helicobacter pylori infection has been implicated as a possible cause of extraintestinal disorders such as skin diseases. A number of case reports describe patients with skin diseases, such as prurigo nodularis, that are associated with gastric cancer. AIM: The aim of this study was to examine the prevalence of H. pylori infection and the incidence of gastric cancer in patients with pruritic skin diseases. METHODS: The patients were examined for circulating specific IgG antibodies against H. pylori in sera using ELISA. H. pylori-positive patients who were more than 40 years old underwent endoscopic screening for gastric cancer. RESULTS: We examined 134 patients with pruritic skin diseases, including 55 cases of cutaneous pruritus, 21 cases of prurigo chronica multiforme, 15 cases of nummular dermatitis and 43 cases of chronic urticaria. Early gastric cancer was detected in 2/36 (5.6%) patients with cutaneous pruritus and 3/16 (18.8%) with prurigo chronica multiforme. The prevalence of early gastric cancer was 5.6%, which was much higher than that among patients undergoing general endoscopic screening for gastric cancer. CONCLUSIONS: These results suggest that H. pylori-positive patients with pruritic skin diseases may be at increased risk for development of gastric cancer, and endoscopic screening in such patients is recommended.

Slow acetylator genotypes as a possible risk factor for infectious mononucleosis-like syndrome induced by salazosulfapyridine.

We report two patients with infectious mononucleosis-like syndrome induced by salazosulfapyridine (SASP). In both cases, high fever, skin rash, liver dysfunction and atypical lymphocytosis developed 3 weeks after initiating treatment with SASP. SASP is known to be mainly metabolized by N-acetyltransferase 2 (NAT2), and acetylation phenotypes (rapid, intermediate and slow acetylator) correlate with NAT2* genotypes. In our two patients, we investigated NAT2* genotypes by the polymerase chain reaction-restriction fragment length polymorphism method. We identified NAT2*6/*7 in one patient, and NAT2*6/*5 in the other, suggesting that both were slow acetylator phenotypes. In 20 healthy volunteers we found no slow acetylator genotypes. Genotyping prior to medication may be useful in evaluating patients with a high risk of severe systemic reaction to SASP.

Beneficial effect of Helicobacter pylori eradication in dermatologic diseases.

BACKGROUND: A relationship between skin diseases, particularly rosacea and chronic urticaria, and H. pylori infection has been suggested. METHODS: We preformed a prospective evaluation of the effect of H. pylori eradication in patients with a variety of chronic skin diseases. Patients were followed monthly for at least one year after cure of the infection. The effect of therapy was scored using a three point scale: complete remission (> 90% improvement), partial remission (50-90% improvement) or no improvement (< 50 improvement). The relationship between response and anti-H. pylori Ig G and E to specific H. pylori antigens was analyzed by Western blot analysis. RESULTS: Eighty-eight H. pylori-infected patients with skin disease were enrolled. Treatment was successful in 73% of patients with chronic urticaria as 23% (6 of 26) had complete and 50% had partial remission. Sixty-two percent (18 of 29) with pruritus cutaneus had partial remission as well as 30% with prurigo chronica multiformis had complete remission. Western blotting was done on 24 patients with skin disease and a 44K H. pylori antigen was detected by Ig E analysis in 100% (5 of 5) patients with complete remission compared to 23% (3 of 13) in those without skin disease. CONCLUSIONS: These results suggest it may be prudent to test patients with chronic urticaria, prurigo chronica multiformis, pruritus cutaneus, and eczema nummulare for H. pylori infection and to eradicate the infection in those whose test is positive.

T1 and T2 lip cancer: a superselective method of facial arterial infusion therapy--preliminary experience.

PURPOSE: To formulate and evaluate a facial arterial infusion chemotherapy for squamous cell lip carcinoma. MATERIALS AND METHODS: The study included six patients (age range, 46-84 years) with squamous cell carcinoma of the lower lip. There were two T1 tumors, three T2 tumors, and one T1-compatible postoperative recurrent tumor. A 4-F, double-lumen balloon catheter was inserted into the external carotid artery through the superficial temporal artery and placed for selective infusion into the tumor-feeding facial artery. Patients received a combination of mitomycin C (4.4 mg/m2 per body surface area) on day 1 and 3.2 mg/m2 of peplomycin sulfate on days 1-7 (22.4 mg/m2 per week), or, when peplomycin sulfate was contraindicated, 16 mg/m2 of cisplatin only on days 1-5 (80 mg/m2 per week). Two to three cycles of chemotherapy were given until tumor disappearance was histologically confirmed. RESULTS: Complete tumor disappearance was achieved in all cases. One patient had a self-limiting asthma attack during peplomycin sulfate treatment, and another had transient partial hair loss. No disfigurement, recurrence, or late complications were observed at a mean follow-up of 5.0 years (range, 2.3-11.2 years). CONCLUSION: The described facial arterial infusion chemotherapy appears to be a safe and curative treatment for T1 and T2 squamous cell lip carcinomas.

Double filtration plasmapheresis for the treatment of bullous pemphigoid: a three case report.

Bullous pemphigoid (BP) is an autoimmune disease caused by an antidermal basal lamina antibody. In recent years double filtration plasmapheresis (DFPP) has been reported to be an effective therapy for BP. We experienced 3 cases of BP treated by DFPP. DFPP resulted in an improvement in clinical symptoms and remission allowing a decrease in the required dose of corticosteroid. DFPP was found to be an effective treatment for all 3 patients without noticeable adverse events resulting from DFPP. From these results it is concluded that DFPP is worth considering as an option as treatment for BP patients who were unresponsive to conventional steroid therapy, those in whom corticosteroids should be reduced or discontinued because of complications such as diabetes mellitus and/or osteoporosis.