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).
Carcinoma, Hepatocellular , Jaundice, Obstructive , Liver Neoplasms , Humans , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/therapy , Male , Liver Neoplasms/complications , Liver Neoplasms/mortality , Liver Neoplasms/therapy , Liver Neoplasms/pathology , Female , Middle Aged , Africa South of the Sahara/epidemiology , Adult , Jaundice, Obstructive/etiology , Jaundice, Obstructive/therapy , Retrospective Studies , Jaundice/etiology , Survival Rate , Treatment Outcome , Aged
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.
Dermatomyositis/pathology , Exanthema/pathology , Calcinosis/etiology , Dermatomyositis/complications , Facial Dermatoses/pathology , Hand Dermatoses/pathology , Humans , Leg Dermatoses/pathology , Panniculitis/etiology , Scalp Dermatoses/pathology , Torso/pathology
Coronavirus Infections/diagnosis , Dermatologists/organization & administration , Hospitals, Urban/organization & administration , Personnel Staffing and Scheduling , Pneumonia, Viral/diagnosis , Referral and Consultation/organization & administration , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , COVID-19 , Clinical Competence , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Critical Care/organization & administration , Humans , London/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Professional Role , SARS-CoV-2
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.
Contrast Media/adverse effects , Hypersensitivity, Delayed/chemically induced , Iodine/adverse effects , Skin Diseases/chemically induced , Acute Generalized Exanthematous Pustulosis/etiology , Aged , Exanthema/chemically induced , Female , Humans , Male , Middle Aged , Skin Diseases/pathology , Stevens-Johnson Syndrome/etiology
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.
Contrast Media/adverse effects , Gadolinium/adverse effects , Hypersensitivity, Immediate/chemically induced , Skin Diseases/chemically induced , Contrast Media/pharmacokinetics , Gadolinium/pharmacokinetics , Humans , Tissue Distribution
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.
Malnutrition/history , Pellagra/history , Prisoners/history , Riboflavin Deficiency/history , Skin Diseases/history , World War II , Asia, Eastern , History, 20th Century , Humans , Male , Malnutrition/complications , Pellagra/pathology , Riboflavin Deficiency/pathology , Scrotum/pathology , Skin Diseases/etiology , United Kingdom
Anti-Bacterial Agents/adverse effects , Bile Duct Diseases/etiology , Bile Duct Diseases/surgery , Cephalexin/adverse effects , Liver Transplantation , Stevens-Johnson Syndrome/complications , Stevens-Johnson Syndrome/therapy , Female , Humans , Liver Function Tests , Middle Aged , Syndrome , Urinary Tract Infections/drug therapy
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.
Stevens-Johnson Syndrome/complications , Adult , Aftercare , Child, Preschool , Chronic Disease , Digestive System Diseases/etiology , Digestive System Diseases/therapy , Eye Diseases/etiology , Eye Diseases/therapy , Female , Female Urogenital Diseases/etiology , Female Urogenital Diseases/therapy , Humans , Kidney Diseases/etiology , Kidney Diseases/therapy , Lung Diseases/etiology , Lung Diseases/therapy , Male , Male Urogenital Diseases/etiology , Male Urogenital Diseases/therapy , Mouth Diseases/etiology , Mouth Diseases/therapy , Patient Care Team , Skin Diseases/etiology , Skin Diseases/therapy , Stevens-Johnson Syndrome/prevention & control , Survivors , Tooth Diseases/etiology , Tooth Diseases/therapy
Carcinoma, Basal Cell/complications , Foot Deformities/etiology , Hand Dermatoses/etiology , Hypotrichosis/complications , Psoriasis/etiology , Skin Neoplasms/complications , Aged , Carcinoma, Basal Cell/diagnosis , Diagnosis, Differential , Female , Foot Deformities/diagnosis , Hand Dermatoses/diagnosis , Humans , Hypotrichosis/diagnosis , Positron Emission Tomography Computed Tomography , Psoriasis/diagnosis , Skin/pathology , Skin Neoplasms/diagnosis
Stevens-Johnson Syndrome/therapy , Adrenal Cortex Hormones/therapeutic use , Adult , Aftercare , Analgesia/methods , Biological Dressings , Critical Pathways , Cyclosporine/therapeutic use , Eye Diseases/therapy , Female , Female Urogenital Diseases/therapy , Fluid Therapy/methods , Forecasting , Humans , Immunoglobulins, Intravenous/therapeutic use , Lymphocyte Activation , Male , Male Urogenital Diseases/therapy , Mouth Diseases/therapy , Nutritional Support/methods , Prognosis , Respiratory Tract Diseases/therapy , Skin Care/methods , Skin Irritancy Tests/methods , Stevens-Johnson Syndrome/etiology , Stevens-Johnson Syndrome/pathology
