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Small Ulcer (small + ulcer)
Selected Abstracts,Lues maligna" bei insulinpflichtigem Diabetes mellitusJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 10 2005"Lues maligna" in a female patient with diabetes Zusammenfassung Bei einer 40-jährige Patientin mit insulinpflichtigem Diabetes mellitus traten innerhalb weniger Wochen vor allem am Stamm multiple bis 2,5,cm große, lividrote Knoten und Plaques auf, die rasch ulzerierten. Einige Monate zuvor habe beim Partner ein kleines Ulkus am Penis bestanden. Die HIV-negative Patientin hatte eine hochtitrig positive Syphilisserologie (TPPA-Titer >,1 : 20.480, VDRL-Titer 1 : 128). Die nüchtern Blutglukosewerte lagen über 275,mg/dl. Nach Ausschluss einer Neurolues stellten wir die Diagnose einer ,Lues maligna" bei schlecht eingestelltem Diabetes mellitus. Unter einer Therapie mit 3,Injektionen Benzylpenicillin-Benzathin (2,4,Mio.,IE) i. m. in wöchentlichen Abständen und Einstellung des Diabetes heilten die Hautveränderungen komplett ab. Im Verlauf war der VDRL-Titer negativ. Die ,Lues maligna" tritt seit einigen Jahren wieder gehäuft auf und wird vor allem bei HIV-positiven Männern beobachtet. Das Auftreten dieser Erkrankung bei durch Diabetes mellitus bedingter Immunsuppression ist ausgesprochen selten. Summary A 40-year-old female patient with diabetes mellitus presented with multiple erythematous ulcerated nodules and plaques predominantly on the trunk. A few months ago her partner had a small ulcer on the penis. She was HIV negative but showed markedly elevated syphilis serology titers (TPPA titer >,1 : 20.480, VDRL titer 1 : 128). The serum glucose levels exceeded 275,mg/dl. After exclusion of neurological involvement, we made the diagnosis of ,lues maligna" arising in the setting of diabetes mellitus. The patient was treated with 2.4 million units benzathine penicillin intramuscularly weekly for three weeks. Simultaneously, diabetes therapy was improved with insulin injections. The syphilitic lesions cleared rapidly. In the follow-up VDRL titer was negative. ,Lues maligna" is an unusual ulcerative variant of secondary syphilis which has been observed more frequently in HIV-infected patients in the last years. The occurrence of this aggressive variant in the clinical setting of diabetes mellitus is extremely rare. [source] Clinical and endoscopic characteristics of acute haemorrhagic rectal ulcer, and endoscopic haemostatic treatment: a retrospective study of 95 patientsCOLORECTAL DISEASE, Issue 10Online 2010Y. Motomura Abstract Aim, Acute haemorrhagic rectal ulcer (AHRU) is characterized by sudden onset of painless and massive rectal bleeding in elderly bedridden patients who have serious illness. Endoscopic diagnosis and management of AHRU is, however, still controversial. We retrospectively investigated 95 AHRU patients to elucidate the clinical characteristics, endoscopic findings and haemostatic strategies. Method, Between January 1999 and March 2007, 95 patients were diagnosed with AHRU in our hospital. Medical records and colonoscopy files were reviewed. Clinical features, colonoscopic findings, haemostatic treatment and outcome of the patients were evaluated. Results, Eighty per cent of the patients were bedridden at the onset. The most frequent underlying disorder was cerebrovascular disease (36.8%). Hypoalbuminaemia (< 3.5 g/dl) was seen in 92.6% of the patients. Endoscopic findings of AHRU were classified as circumferential ulcer (41.1%), linear or nearly round small ulcer(s) (44.2%), circumferential and small ulcer(s) (7.4%) and Dieulafoy-like ulcer (7.4%). Primary endoscopic haemostatic treatment was performed in 45.3% of cases. Recurrent bleeding occurred in 24.2% of patients. Permanent haemostasis was achieved by secondary endoscopic treatment in 82.6% of re-bleeding patients. Conclusion, Understanding the typical clinical and endoscopic findings and careful endoscopic examination are important for the accurate diagnosis of AHRU, and endoscopic haemostatic therapy may be effective for bleeding patients. [source] Pyoderma gangrenosum of the scalp treated with cyclosporine AINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2002Pasquale Patrone MD A 56-year-old woman presented with an ulcer, with a depth of 9 mm, on the vertex and frontal parietal regions of the scalp. The lesion had a round shape (diameter, 7 cm), with clear-cut margins and vertical borders sinking vertically to a bottom that was entirely covered with purulent fibrinous yellowish matter and greenish colored necrotic tissue. Other numerous small roundish ulcers were present next to the large ulcer. These had irregular margins with a yellowish fibrinous bottom (Fig. 1). The patient reported the appearance of two small ulcers on the left and on the right frontal parietal regions about 1 year earlier. These had been treated locally with antimicrobials and antiseptics with no result. During the 2 months prior to our evaluation, a few small round-shaped ulcers had appeared on the scalp. These had progressively increased in size and number. Figure Figure 1 . Large ulcer with clear-cut margins, covered by purulent fibrinous matter, and other small roundish ulcers The patient had been an insulin-dependent diabetic for 23 years. Hematochemical examinations showed no significant alterations, except for a rise in glycemia. Urine examination gave normal results. Carcinoembryonic antigen and lymphocytic phenotyping indices were normal. Echographic, endoscopic, and radiocontrast studies of the abdomen did not reveal the presence of lesions either in the gastrointestinal tract or in other organs. Samples of ulcerous tissue were collected from the scalp to perform histologic and microbiologic analysis in search of fungi and bacteria. This last examination revealed the presence of Staphylococcus aureus and Candida parapsylosis. Direct search for mycobacteria was negative. Histology indicated the presence of dermal granulomatous inflammation with giant multinucleate cells, associated with large zones of suppuration and colliquative necrosis. While waiting to complete the diagnostic course, topical antiseptic, antimicrobial, and fibrinolytic therapy was administered; subsequently, as this did not lead to any improvement, systemic treatment with cyclosporine A (5 mg/kg/day) was started. Rapid improvement of the clinical picture occurred. The ulcers appeared cleaner from the first 2 weeks of treatment, radial growth stopped, and the margins were slightly more superficial. The patient continued with immunomodulating therapy at home over a period of 7 months. The dose was progressively reduced until, over a period of about 3 months, complete re-epithelialization of the lesion, with subsequent partial regrowth of the hair, was obtained (Figs 2 and 3). No relapses were observed 1 year after treatment was suspended. Figure 2. Partial re-epithelialization of the lesion with partial regrowth of the hair Figure 3. Scar and hair regrowth [source] Leukocytapheresis treatment for pyoderma gangrenosumBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2004E. Fujimoto Summary A 42-year-old man presented with painful erythema with pustules and multiple small ulcers on the shins. He had suffered from ulcerative colitis (UC) and received oral glucocorticosteroid and salicylazosulfapyridine therapies for 7 years. Biopsy of the lesion demonstrated mixed cellular infiltrates with dominant neutrophils. The patient was diagnosed with pyoderma gangrenosum (PG) and underwent leukocytapheresis (LCAP), an extracorporeal leucocyte removal therapy, once a week for 5 weeks without changing the doses of the oral medications. The skin lesions as well as clinical signs of UC rapidly improved after LCAP, and no recurrence was seen during a follow-up period. There were no major complications during LCAP. LCAP will provide an effective and safe tool for the treatment of PG. [source] | ||||||||||