A Case of Severe Refractory Pemphigus Vulgaris in a Patient With Stable Esophageal Malignancy.

Pemphigus is a broad term that is used to describe a group of bullous autoimmune diseases affecting the skin and mucous membranes; the pathogenesis involves autoantibodies directed against various cell junction desmosomal proteins. In patients with a history of malignancy who present with bullous lesions, the differential diagnosis may include, but is not limited to, paraneoplastic pemphigus (PNP) and pemphigus vulgaris (PV) secondary to a primary autoimmune process, or induced by chemotherapy or radiation therapy. In this report, we present a case of refractory PV in a patient with stable esophageal cancer, five years after undergoing radiation therapy. He was poorly responsive to corticosteroids and intravenous immunoglobulin (IVIG). PNP or PV in a patient with stable esophageal malignancy has not been previously reported. PNP and PV can have overlapping autoantigens [desmoglein types 1 and 3 (DSG1 and DSG3)] as well as similar presentations. Thus, distinguishing between the two may be challenging in a patient with a history of cancer. More research must be done to determine if PNP can be seen in a patient with stable esophageal malignancy and, similarly, if PV can be precipitated by stable esophageal malignancy. Such research would aid in determining whether or not similar presentations are more severe or refractory to standard treatment regimens, thereby contributing to improve treatment strategies.

Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition.

BACKGROUND: Previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. OBJECTIVE: To determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. METHODS: Six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. RESULTS: Of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. CONCLUSION: Dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital.

Sterilization analysis of contaminated healing abutments and impression copings.

This study investigated sterilization of used implant impression copings and healing abutments. Components were analyzed after contamination with Enterococcus foecalis, followed by multiple rounds of sterilization by both steam autoclave and Chemiclave protocols. The authors' results demonstrated that used components showed sterility equal to new components without any visible distortion. These data suggest that component resterilization and reuse may be justified or at least considered in clinical practice. Also, implications for cost savings in the placement of implants are advanced.