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Kunovsky L, Dite P, Brezinova E, Sedlakova L, Trna J, Jabandziev P. Skin manifestations of pancreatic diseases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:353-358. [PMID: 35938387 DOI: 10.5507/bp.2022.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022] Open
Abstract
Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.
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Affiliation(s)
- Lumir Kunovsky
- Department of Surgery, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Czech Republic.,Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Dite
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Czech Republic.,Faculty of Medicine, University of Ostrava, Czech Republic
| | - Eva Brezinova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,1st Department of Dermatovenerology, St. Anne's University Hospital, Brno, Czech Republic
| | - Libuse Sedlakova
- Department of Dermatology, Military Hospital Brno, Czech Republic
| | - Jan Trna
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Jabandziev
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Pediatrics, University Hospital Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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2
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Selvaraj V, Dapaah-Afriyie K. A Tale of Two Ps: Panniculitis Secondary to Acute Pancreatitis. Cureus 2021; 13:e20504. [PMID: 35070542 PMCID: PMC8763359 DOI: 10.7759/cureus.20504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/12/2022] Open
Abstract
Pancreatic panniculitis (PP) is a rare variant of panniculitis that affects patients with pancreatic disorders, most commonly pancreatic malignancy or acute/chronic pancreatitis. Patients often present with painful, erythematous nodules on their lower extremities that may undergo spontaneous ulceration and necrosis. Treatment is largely supportive and should address the underlying pancreatic disease.
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3
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Miulescu R, Balaban DV, Sandru F, Jinga M. Cutaneous Manifestations in Pancreatic Diseases-A Review. J Clin Med 2020; 9:E2611. [PMID: 32806580 PMCID: PMC7464368 DOI: 10.3390/jcm9082611] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology.
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Affiliation(s)
- Raluca Miulescu
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
| | - Daniel Vasile Balaban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Florica Sandru
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
| | - Mariana Jinga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
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4
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Hernández J, Sanz A, Isla-Tejera B, Ruano J. Pyoderma gangrenosum-like necrotizing panniculitis associated with Imatinib: A case report. Dermatol Reports 2020; 12:8381. [PMID: 32685125 PMCID: PMC7366129 DOI: 10.4081/dr.2020.8381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 06/20/2020] [Indexed: 01/19/2023] Open
Abstract
Imatinib mesylate is a small tyrosine kinase inhibitor that targets BCR-ABL, ckit and platelet-derived growth factor receptor. It is prescribed by hematologists for chronic myeloid leukemia and acute lymphoblastic leukemia and by oncologists for Gastrointestinal Stromal Tumors (GIST). Cutaneous reactions to Imatinib are common but their incidence and severity widely varies between patients. A self-limited skin rash is the most common adverse effect but there have been reported cases of patients with maculopapular rash, pigmentary changes, superficial edema and rarer and clinically distinctive features such as lichenoid reactions or psoriasis. We here describe for the first time a case of pyoderma gangrenosum-like necrotizing panniculitis, a rare dermatological condition, after initiating therapy with Imatinib.
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Affiliation(s)
- Jorge Hernández
- Department of Pharmacy, Reina Sofía University Hospital.,Instituto Maimonides de Investigacion Biomedica de Cordoba - IMIBIC, Reina Sofía University Hospital, University of Cordoba
| | - Alicia Sanz
- Department of Pathology, Reina Sofía University Hospital
| | - Beatriz Isla-Tejera
- Department of Pharmacy, Reina Sofía University Hospital.,Instituto Maimonides de Investigacion Biomedica de Cordoba - IMIBIC, Reina Sofía University Hospital, University of Cordoba
| | - Juan Ruano
- Instituto Maimonides de Investigacion Biomedica de Cordoba - IMIBIC, Reina Sofía University Hospital, University of Cordoba.,Department of Dermatology, Reina Sofía University Hospital, Córdoba, Spain
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5
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Johnson EF, Tolkachjov SN, Gibson LE. Alpha-1 antitrypsin deficiency panniculitis: clinical and pathologic characteristics of 10 cases. Int J Dermatol 2018; 57:952-958. [DOI: 10.1111/ijd.14012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/14/2018] [Accepted: 04/02/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Lawrence E. Gibson
- Department of Dermatology; Mayo Clinic; Rochester MN USA
- Division of Dermatopathology; Mayo Clinic; Rochester MN USA
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6
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Sabbagh DK, Barmayehvar B, Nguyen T, Edgar RG, Turner AM. Managing panniculitis in alpha-1 antitrypsin deficiency: Systematic review of evidence behind treatment. World J Dermatol 2018; 7:1-8. [DOI: 10.5314/wjd.v7.i1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/27/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To systematically review literature for management of alpha-1 antitrypsin deficiency (AATD) panniculitis.
METHODS Multiple databases were searched using combinations of pertinent terms. Articles were selected describing panniculitis treatment in patients with AAT < 11 μmol and/or PiZZ genotype, with no language limitation. All relevant articles were accessed in full text. Independent review of abstracts and full manuscripts was conducted by 2 reviewers, and quality assessment by one reviewer (checked by a second). Data extraction was conducted by one reviewer (checked by a second). Narrative synthesis only was conducted, as data were unsuitable for meta-analysis.
RESULTS Thirty-two case reports and 4 case series were found. Augmentation therapy (infusions of plasma-derived AAT) was the most successful, with complete resolution of symptoms in all patients. Dapsone is a less expensive option, and it achieved clinical resolution in 62% of patients, but it is very poorly tolerated. Among other single-agent antibiotics, doxycycline was the most successful with complete clinical resolution seen in 33% of patients. Immunosuppressants were largely unsuccessful; 80% of patients exhibited no response. Liver transplantation and therapeutic plasma exchange displayed complete resolution in 66% of patients. Other strategies, such as non-steroidal anti-inflammatory drugs or antibiotics other than dapsone did not show sufficient response rates to recommend their use. Authors note the risk of bias imposed by the type of evidence (case reports, case series) available in this field.
CONCLUSION Dapsone is the recommended first line therapy for AATD panniculitis, followed by augmentation therapy. Plasma exchange may be an alternative in the setting of rapidly progressive disease.
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Affiliation(s)
- Donah K Sabbagh
- the Medical Research Institute of New Zealand (MRINZ), CSB Building, Wellington Hospital, Newtown, Wellington 6021, New Zealand
| | - Behrad Barmayehvar
- Department of Colorectal Surgery, the Royal Wolverhampton Trust, Wolverhampton Road, West Midlands WV10 0QP, United Kingdom
| | - Thanh Nguyen
- Department of Intensive Care, United Lincolnshire Hospitals NHS Trust, Lincolnshire LN2 4AX, United Kingdom
| | - Ross G Edgar
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WG, United Kingdom
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
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7
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Kim EJ, Chu MS, Sohn KC, Cho DH, Na GH, Kim HC, Cho EY. [Pancreatic Panniculitis in Patients with Chronic Pancreatitis: Case Report and Review of Literature]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 69:83-86. [PMID: 28135797 DOI: 10.4166/kjg.2017.69.1.83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pancreatic panniculitis is a rare complication characterized by subcutaneous fat necrosis associated with pancreatic disease. It has been postulated that pancreatic panniculitis is caused by the systemic activity of pancreatic enzymes that lead to microcirculatory disturbances. We report a 41-year-old heavy alcoholic woman with pancreatic panniculitis that coexisted with acute and chronic pancreatitis. She was diagnosed with chronic pancreatitis and alcoholic liver cirrhosis 5 years ago. She presented with multiple, tender, erythematous, subcutaneous nodules with heat sensation on both lower legs. Laboratory evaluation revealed an increase in the serum blood amylase and lipase. Histopathologic findings showed fat necrosis with inflammation around the necrotic subcutaneous fat tissue. The lesions subsided gradually with an improvement of acute pancreatitis.
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Affiliation(s)
- Eui Joong Kim
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Min Su Chu
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Ki Chang Sohn
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Dong Ho Cho
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Ga Hye Na
- Department of Dermatology, Wonkwang University College of Medicine, Iksan, Korea
| | - Haak Cheoul Kim
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Eun Young Cho
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
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Zhang G, Cao Z, Yang G, Wu W, Zhang T, Zhao Y. Pancreatic panniculitis associated with pancreatic carcinoma: A case report. Medicine (Baltimore) 2016; 95:e4374. [PMID: 27495045 PMCID: PMC4979799 DOI: 10.1097/md.0000000000004374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Pancreatic panniculitis is a very rare complication of pancreatic cancer, most often accompanying rare acinar cell carcinoma. We herein report a case of pancreatic panniculitis that was associated with pancreatic mucinous adenocarcinoma. PATIENT INFORMATION A 57-year-old male was referred to our hospital for weight loss. A physical examination revealed subcutaneous nodules on his lower extremities. The blood test showed abnormal increases in amylase, lipase, and carbohydrate antigen 19-9 levels. A computed tomography scan detected a hypodense 2 × 1.5 cm solid mass with an unclear margin in the head of the pancreas. The biopsy of subcutaneous nodules on the lower extremities was conducted and revealed lobular panniculitis. Pancreatic cancer and pancreatic panniculitis were strongly suspected. After the administration of octreotide acetate and the Whipple procedure, the serous amylase and lipase levels returned to normal, and the pancreatic panniculitis had almost resolved by 4 weeks later. CONCLUSION Pancreatic panniculitis is a rare complication of pancreatic cancer. However, in the presence of a pancreatic mass, as in this case, clinicians should be aware that panniculitis may be the sentinel of pancreatic carcinoma.
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Affiliation(s)
| | | | | | | | - Taiping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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9
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Gandhi S, Arami H, Krishnan KM. Detection of Cancer-Specific Proteases Using Magnetic Relaxation of Peptide-Conjugated Nanoparticles in Biological Environment. NANO LETTERS 2016; 16:3668-3674. [PMID: 27219521 DOI: 10.1021/acs.nanolett.6b00867] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Protease expression is closely linked to malignant phenotypes of different solid tumors; as such, their detection is promising for diagnosis and treatment of cancers, Alzheimer's, and vascular diseases. Here, we describe a new method for detecting proteases by sensitively monitoring the magnetic relaxation of monodisperse iron oxide nanoparticles (IONPs) using magnetic particle spectrometer (MPS). In this assay, tailored peptides functioning as activatable nanosensors link magnetic nanoparticles and possess selective sites that are recognizeable and cleaveable by specific proteases. When these linker peptides, labeled with biotin at N- and C-terminals, are added to the neutravidin functionalized IONPs, nanoparticles aggregate, resulting in well-defined changes in the MPS signal. However, as designed, in the presence of proteases these peptides are cleaved at predetermined sites, redispersing IONPs, and returning the MPS signal(s) close to its preaggregation state. These changes observed in all aspects of the MPS signal (peak intensity, its position as a function of field amplitude, and full width at half-maximum-when combined, these three also eliminate false positives), help to detect specific proteases, relying only on the magnetic relaxation characteristics of the functionalized nanoparticles. We demonstrate the general utility of this assay by detecting one each from the two general classes of proteases: trypsin (digestive serine protease, involved in various cancers, promoting proliferation, invasion, and metastasis) and matrix metalloproteinase (MMP-2, observed through metastasis and tumor angiogenesis). This MPS based protease-assay is rapid, reproducible, and highly sensitive and can form the basis of a feasible, high-throughput method for detection of various other proteases.
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Affiliation(s)
- Sonu Gandhi
- Materials Science & Engineering Department, University of Washington , Seattle, Washington 98195-2120 United States
| | - Hamed Arami
- Materials Science & Engineering Department, University of Washington , Seattle, Washington 98195-2120 United States
| | - Kannan M Krishnan
- Materials Science & Engineering Department, University of Washington , Seattle, Washington 98195-2120 United States
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10
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Cardoso J. Panniculitis associated with alpha-1 antitrypsin deficiency: from early descriptions to current targeted therapy. Br J Dermatol 2016; 174:711-2. [DOI: 10.1111/bjd.14487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- J.C. Cardoso
- Department of Dermatology; Coimbra Hospital and University Centre; Coimbra Portugal
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11
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Yu Y, Rubin AG, Gee S, Banker S, Kim CN. Ulcerative panniculitis with fevers and pleural effusions: A unique case of α1-antitrypsin deficiency. JAAD Case Rep 2015; 1:1-2. [PMID: 27075122 PMCID: PMC4802580 DOI: 10.1016/j.jdcr.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Laureano A, Mestre T, Ricardo L, Rodrigues AM, Cardoso J. Pancreatic panniculitis - a cutaneous manifestation of acute pancreatitis. J Dermatol Case Rep 2014; 8:35-7. [PMID: 24748910 DOI: 10.3315/jdcr.2014.1167] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/20/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreatic panniculitis is a rare complication of pancreatic disease occurring in 2% to 3% of all patients, most commonly those with acute or chronic pancreatitis. MAIN OBSERVATIONS We report the case of a pancreatic panniculitis associated with acute pancreatitis in a 63-year-old man. He presented with a 2-day history of multiple tender subcutaneous nodules, followed by nausea, vomiting, severe epigastric pain and loss of appetite, hours before admission. Laboratory and radiologic findings revealed acute pancreatitis. Histopathological examination from a skin biopsy specimen taken from a nodule showed a mostly lobular panniculitis with "ghost cells", without vasculitis. Nodules disappeared with the resolution of acute pancreatic inflammation, as amylase and lipase levels returned to normal. CONCLUSIONS Panniculitis may be the first manifestation of pancreatic disease. Therefore clinicians must have a high index of suspicion for the diagnosis of pancreatic panniculitis.
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Affiliation(s)
- André Laureano
- Department of Dermatology and Venereology, Hospital de Curry Cabral - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Tiago Mestre
- Department of Dermatology and Venereology, Hospital de Curry Cabral - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Leonel Ricardo
- Department of Gastroenterology, Hospital Fernando da Fonseca, Amadora, Portugal
| | - Ana Maria Rodrigues
- Department of Dermatology and Venereology, Hospital de Curry Cabral - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Jorge Cardoso
- Department of Dermatology and Venereology, Hospital de Curry Cabral - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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Kunimoto BT. Catastrophic wounds. J Cutan Med Surg 2013; 17 Suppl 1:S33-9. [PMID: 24144254 DOI: 10.2310/7750.2013.wound2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND This article summarizes information presented at the Wound Healing Subspecialty Symposium of the Annual Conference of the Canadian Dermatology Association held in Ottawa in June 2012. OBJECTIVE To provide continuing medical education on wound healing for dermatologists. METHODS A review of the pertinent literature was performed by the author in order to prepare the lecture and subsequent article. RESULTS The review found that necrotizing faciitis, hypertensive ulceration, antiphospholipid syndrome and α1-antitrypsin syndrome are entities that contribute to catastrophic wounds seen in wound healing clinics and in private offices. CONCLUSION It is most important to have a high index of suspicion for these four conditions because early diagnosis can be life-saving with necrotizing faciitis, pain-relieving in ulcers caused by hypertension, and antiphospholipid syndrome, and can result in early treatment in α1-antitrypsin deficiency.
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14
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Pfaundler N, Kessebohm K, Blum R, Stieger M, Stickel F. Adding pancreatic panniculitis to the panel of skin lesions associated with triple therapy of chronic hepatitis C. Liver Int 2013; 33:648-9. [PMID: 23410147 DOI: 10.1111/liv.12119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/04/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Nubio Pfaundler
- Department of Visceral Surgery and Medicine; Inselspital, University of Berne; Berne Switzerland
| | - Kerstin Kessebohm
- Center for Clinical Pharmacology and Pharmacovigilance; Inselspital, University of Berne; Berne Switzerland
| | - Roland Blum
- Department of Dermatology; Inselspital, University of Berne; Berne Switzerland
| | - Marco Stieger
- Department of Dermatology; Inselspital, University of Berne; Berne Switzerland
| | - Felix Stickel
- Department of Visceral Surgery and Medicine; Inselspital, University of Berne; Berne Switzerland
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15
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Janciauskiene SM, Bals R, Koczulla R, Vogelmeier C, Köhnlein T, Welte T. The discovery of α1-antitrypsin and its role in health and disease. Respir Med 2011; 105:1129-39. [PMID: 21367592 DOI: 10.1016/j.rmed.2011.02.002] [Citation(s) in RCA: 225] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/24/2011] [Accepted: 02/07/2011] [Indexed: 01/08/2023]
Abstract
α1-Antitrypsin (AAT) is the archetype member of the serine protease inhibitor (SERPIN) supergene family. The AAT deficiency is most often associated with the Z mutation, which results in abnormal Z AAT folding in the endoplasmic reticulum of hepatocytes during biogenesis. This causes intra-cellular retention of the AAT protein rather than efficient secretion with consequent deficiency of circulating AAT. The reduced serum levels of AAT contribute to the development of chronic obstructive pulmonary disease (COPD) and the accumulation of abnormally folded AAT protein increases risk for liver diseases. In this review we show that with the discovery of AAT deficiency in the early 60s as a genetically determined predisposition to the development of early-onset emphysema, intensive investigations of enzymatic mechanisms that produce lung destruction in COPD were pursued. To date, the role of AAT in other than lung and liver diseases has not been extensively examined. Current findings provide new evidence that, in addition to protease inhibition, AAT expresses anti-inflammatory, immunomodulatory and antimicrobial properties, and highlight the importance of this protein in health and diseases. In this review co-occurrence of several diseases with AAT deficiency is discussed.
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