To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center.
Using the International Classification of Diseases, Ninth Revision ...diagnosis code of 275.49 and the keyword "calciphylaxis" in the dismissal narrative, we retrospectively identified 101 patients with calciphylaxis seen at our institution between January 1, 1999, through September 20, 2014, using a predefined, consensus-developed classification scheme.
The average age of patients was 60 years: 81 (80.2%) were women; 68 (68.0%) were obese; 19 (18.8%) had stage 0 to 2 chronic kidney disease (CKD), 19 (18.9%) had stage 3 or 4 CKD; 63 (62.4%) had stage 5 or 5D (dialysis) CKD. Seventy-five patients died during follow-up. Six-month survival was 57%. Lack of surgical debridement was associated with insignificantly lower 6-month survival (hazard ratio HR=1.99; 95% CI, 0.96-4.15; P=.07) and significantly poorer survival for the entire duration of follow-up (HR=1.98; 95% CI, 1.15-3.41; P=.01), which was most pronounced in stage 5 or 5D CKD (HR=1.91; 95% CI, 1.03-3.56; P=.04). Among patients with stage 5/5D CKD, subtotal parathyroidectomy (performed only in patients with hyperparathyroidism) was associated with better 6-month (HR=0.12; 95% CI, 0.02-0.90; P=.04) and overall survival (HR= 0.37; 95% CI, 0.15-0.87; P=.02).
Calciphylaxis is associated with a high mortality rate. Significantly effective treatments included surgical debridement and subtotal parathyroidectomy in patients with stage 5/5D CKD with hyperparathyroidism. Treatments with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with higher mortality.
Summary
Background
In both acute graft‐versus‐host disease (GVHD) and lupus erythematosus (LE), the patient's own tissues are subjected to immunological assault via complex mechanisms influenced by ...interferon (IFN) and other cytokines. Although not typically confused clinically, these entities have overlapping histopathological findings in the skin.
Aim
To assess whether GVHD can be differentiated from LE using molecular methods on skin specimens.
Methods
We developed a quantitative reverse transcription PCR assay based on previously identified tissue‐based biomarkers of cutaneous GVHD, and compared gene expression in GVHD with that in LE.
Results
Both entities showed robust expression of IFN‐induced genes and of genes encoding proteins involved in antigen presentation, cell signalling and tissue repair. Levels of gene expression differed significantly in GVHD compared with LE, particularly those of IFN‐induced genes such as MX1, OAS3, TAP1 and STAT3 (P < 0.01). Three logistic regression models could differentiate the two entities with a high degree of certainty (receiver operating characteristic area under the curve of 1.0).
Conclusion
The study demonstrates the feasibility of distinguishing between microscopically similar inflammatory dermatoses using tissue‐based molecular techniques.
Background Kaposi varicelliform eruption (KVE), or herpes simplex virus (HSV) superinfection of pre-existing skin lesions, may complicate Darier disease. Objective We sought to compare the clinical ...features and outcomes of patients with Darier disease who developed KVE superinfection with those who did not. Methods A 20-year retrospective analysis of 79 patients with Darier disease treated at our institution was performed. Results Eleven (14%) patients developed KVE, of whom 45% required hospitalization for their skin disease during the follow-up period. Patients with KVE had more severe Darier disease ( P = .030) and were more likely to be hospitalized ( P = .015). HSV was detected in erosions without concomitant vesicles or pustules in 64% of confirmed cases. In all, 23 (55%) patients with erosions had HSV testing pursued. Limitations Retrospective study design is a limitation. Conclusion The majority of KVE occurs in painless or painful erosions that may also appear impetiginized without vesicle or pustule formation. As HSV superinfection is correlated with severe Darier disease and risk for hospitalization, increased recognition of this phenomenon may lead to better patient outcomes.
We have developed a facile and scalable chemical redaction method assisted by microwave irradiation for the synthesis of chemically converted graphene sheets and metal nanoparticles dispersed on the ...graphene sheets. The method allows rapid chemical reduction of exfoliated graphite oxide (GO) using a variety of reducing agents in either aqueous or organic media. It also allows the simultaneous reduction of GO and a variety of metal salts thus resulting in the dispersion of metallic and bimetallic nanoparticles supported on the large surface area of the thermally stable 2D graphene sheets.
To identify coagulation risk factors in patients with calciphylaxis and the relationship between anticoagulation use and overall survival.
Study subjects were 101 patients with calciphylaxis seen at ...Mayo Clinic from 1999 to September 2014. Data including thrombophilia profiles were extracted from the medical records of each patient. Survival status was determined using patient registration data and the Social Security Death Index. Survival was estimated using the Kaplan-Meier method, and associations were evaluated using Cox proportional hazards models.
Sixty-four of the 101 patients underwent thrombophilia testing. Of these, a complete test panel was performed in 55 and a partial panel in 9. Severe thrombophilias observed in 60% (33 of 55) of the patients included antiphospholipid antibody syndrome protein C, protein S, or antithrombin deficiencies or combined thrombophilias. Of the 55 patients, severe thrombophilia (85%, 23 of 27) was noted in patients who were not on warfarin at the time of testing (27). Nonsevere thrombophilias included heterozygous factor V Leiden (n=2) and plasminogen deficiency (n=1). For the comparison of survival, patients were divided into 3 treatment categories: Warfarin (n=63), other anticoagulants (n=20), and no anticoagulants (n=18). There was no statistically significant survival difference between treatment groups.
Laboratory testing reveals a strikingly high prevalence of severe thrombophilias in patients with calciphylaxis, underscoring the importance of congenital and acquired thrombotic propensity potentially contributing to the pathogenesis of this disease. These findings may have therapeutic implications; however, to date, survival differences did not vary by therapeutic choice.
The Iran-Iraq war broke out in September 1980. It brought death and suffering to hundreds of thousands of people on both sides and devastated the economies of both countries. It also increased ...international tensions by precipitating new alliances and rearrangement of forces in the already turbulent Middle East. The focus of this book is on the historical, economic and political dimensions of the war between Iraq and Iran. It examines many aspects of what proved to be a very complex conflict; including its long history, its present economic and political setting, the different responses to the war by outside parties and its regional and world implications.
1. Introduction M. S. El Azhary 2. The Historical Antecedents of the Shatt al-Arab Dispute Peter Hünseler 3. Arab Sovereignty over the Shatt al-Arab during the Ka’bide Period Mustafa al-Najjar and Najdat Fathi Safwat 4. Oil and the Iran-Iraq War David E. Long 5. Economic and Political Implications of the War: The Economic Consequences for the Participants John Townsend 6. Development Strategy in Iraq and the War Effort: The Dynamics of Challenge Basil al-Bustany 7. The Attitudes of the Arab Governments towards the Gulf War G. H. Jansen 8. The Attitudes of the Superpowers towards the Gulf War M. S .El Azhary 9. Regional and Worldwide Implications of the Gulf War John Duke Anthony 10. The Prospects for Peace Glen Balfour Paul Notes on contributors. Index.
Multivolume collection by leading authors in the field
Background There are limited large case series of peristomal pyoderma gangrenosum (PPG), an uncommon cause of recalcitrant peristomal ulceration. Objective We sought to further characterize the ...clinical features, causes, treatments, and outcomes of PPG. Methods We conducted a retrospective chart review of patients with PPG seen at Mayo Clinic from January 1996 to July 2013. Results A total of 44 patients had PPG (mean age, 46 years; 32 women 73%); 41 (93%) had inflammatory bowel disease. Mean time to PPG onset after stoma surgery was 5.2 months (excluding 1 outlier). Systemic therapies included corticosteroids (66%), immunosuppressants (41%), biologics (36%), and a combination of systemic treatments (36%). Mean time to reach a complete response was 10.7 weeks. Stoma closure had the greatest complete response (4 of 4 patients, no recurrences). Recurrence after any treatment was documented in 23 of 38 (61%) patients. Stoma relocation/revision recurred in 10 of 15 (67%) patients. Remission occurred in 29 of 31 (94%) patients. Limitations Small sample size and retrospective study design are limitations. Conclusion PPG is strongly associated with inflammatory bowel disease, is predominant in women, and has a prolonged time to onset and high recurrence rate. Systemic corticosteroid or combination therapies and surgical closure can be effective treatments. Timely recognition and management are paramount to achieving early remission.
Background Multiple devices and coatings assist with endovascular insertion of sheaths, catheters, and guide wires. Hydrophilic polymer coatings, a common component of endovascular surgical devices, ...reportedly cause microvascular obstruction and embolization, with various sequelae in organs and soft tissue. Objective We sought to describe clinical and histopathologic features of cutaneous manifestations of hydrophilic polymer gel emboli. Methods We evaluated the clinical and histopathologic characteristics of 8 patients with cutaneous complications of hydrophilic polymer gel emboli who presented in May 2013 through February 2015. Results Sudden onset of lower extremity livedo racemosa, purpuric patches, or both, occurred hours to days after endovascular procedures involving the aorta. Histopathologic evaluation showed basophilic lamellated material, consistent with hydrophilic polymer gel emboli, within small dermal vessels. Limitations This was a retrospective study with small sample size and not controlled for all similar procedures in this population. Conclusion Hydrophilic polymer gel coatings in endovascular devices can embolize to skin and cause microvascular occlusion, presenting as livedo racemosa, purpura, or both. Given the number of patients observed over a short period, this phenomenon may be underappreciated. Hydrophilic polymer gel emboli should be considered in differential diagnosis of livedo racemosa and purpura after endovascular procedure.
Background At our institution, hospitalization for intensive treatment (combining wet dressings and topical corticosteroids) is a primary intervention for severe pediatric atopic dermatitis. Prior ...reports of this treatment are limited. Objective We sought to review the efficacy of wet dressings for pediatric atopic dermatitis. Methods We reviewed records of pediatric patients hospitalized from January 1, 1980, through April 20, 2010, who received intensive topical treatments for atopic dermatitis. Results In total, 218 pediatric patients had widespread atopic dermatitis severe enough to warrant hospitalization, despite prior outpatient topical treatments and other interventions such as immunomodulating agents, phototherapy, dietary manipulation, or contact allergen avoidance. Mean (SD) age was 5.97 (4.91) years (range, 2 months-17 years); 141 patients (65%) were female. There were 266 hospitalizations: 192 patients (72%) had one admission, 15 (6%) had two admissions, and 11 (4%) had 3 or more admissions. Mean (SD) duration of hospitalization was 3.61 (2.23) days (range, 1-16 days). Upon discharge, all patients showed improvement. In 239 of 266 hospitalizations, patient records showed quantification of improvement (global assessment): 121 (45%) had 75% to 100% improvement, 102 (38%) had 50% to 75% improvement, and 16 (6%) had 25% to 50% improvement. Limitations This was a retrospective study. Conclusion Intensive inpatient treatment (with wet dressings and topical corticosteroids) was highly effective in controlling severe and recalcitrant atopic dermatitis. Intensive topical treatment, although underused, is an effective first-line approach for patients with severe atopic dermatitis.
Patch testing is a diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. A standard series of allergens similar to that used by the North American Contact ...Dermatitis Group (NACDG) is used at Mayo Clinic.
Our aim was to report the results of patch testing with a standard series at Mayo Clinic from July 1, 1998, to Dec 31, 2000 and to compare our findings with those of the NACDG during the same period.
The results of patch testing with the standard series at Mayo Clinic were examined. Positive reaction rates were compared between Mayo Clinic and the NACDG.
During the 30-month period, 1324 Mayo Clinic patients were patch tested with a standard series of allergens (mean, 60 allergens), whereas the NACDG standard series during this period included 50 allergens. Overall, 917 patients (69.3%) had at least one positive reaction and 606 patients (45.8%) had two or more positive reactions. The 10 allergens used both by Mayo Clinic and by the NACDG that most frequently caused positive reactions were nickel sulfate hexahydrate, balsam of Peru
(Myroxylon pereirae), neomycin sulfate, cobalt chloride, fragrance mix, potassium dichromate (0.25%), thimerosal, bacitracin, formaldehyde, and glutaraldehyde. Statistically significant differences in positive reaction rates (
P < .05) were observed for 12 of the 43 allergens common to both Mayo Clinic and the NACDG.
With large standard patch test series, one can identify commonly encountered and potentially relevant contact allergens.
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