Irena Walecka

Long-Term Cefuroxime Axetil in Subacute Cutaneous Lupus erythematosus

Background: Subacute cutaneous lupus erythematosus (SCLE) is a subset of lupus erythematosus characterized mainly by prominent photoaggravated cutaneous manifestations. Standard therapies for SCLE include topical or systemic steroids and antimalarial drugs. Both methods show limited efficacy in clearing cutaneous lesions and occasionally produce serious side effects. Aim: To assess the efficacy of cefuroxime axetil, an oral cephalosporin with antibacterial and immunosuppressive activity, in patients with SCLE. Methods: Three patients with SCLE were treated with cefuroxime axetil at a daily dose of 500 mg for 30–60 days. Results: In all patients complete clearing of skin lesions was achieved and no side effects were observed. Conclusion: We suggest that long-term cefuroxime axetil administration might be an alternative treatment for patients with SCLE skin lesions.

C-reactive protein as the indicator of severity in ovarian hyperstimulation syndrome

Background. To establish correlations between laboratory findings and clinical symptoms of moderate and severe ovarian hyperstimulation syndrome (OHSS). Design. A retrospective study. Setting. Department of obstetrics and gynecology, public clinical hospital. Patients. Nineteen women admitted to the public hospital with a diagnosis of OHSS. The procedure of controlled ovarian stimulation (COH) was performed in the private assisted reproductive technology centre. Methods. Blood samples were collected, ultrasound examination of ovaries, abdominal circumference measurement were performed, intravenous crystalloids, plasma expanders such colloids and albumin were given. Correlations between mean laboratory results (haematocrit, c-reactive protein (CRP), white blood count, serum protein, serum albumin), ovarian size in ultrasound examination, abdominal circumference, and amount of albumin and hydroxyethyl starch transfused to the patient were assessed. Results. Significant correlation was observed between CRP concentration and abdominal circumference measured when the patient was admitted to the department, between CRP concentration and ovarian size measured during ultrasound examination at admission and between CRP concentration and body weight. Conclusions. CRP can be a potential candidate to an indicator of OHSS severity.

Cutaneous Adverse Reactions of Amiodarone

Dermatological complications of amiodarone are commonly encountered problems in therapy. The incidence in the population of patients with prolonged use of amiodarone reaches nearly 75% according to various sources. Nevertheless, they are often misdiagnosed or overlooked. The aim of this review is to present the current state of knowledge about skin changes induced by amiodarone, including phototoxic and photoallergic reactions, as well as hyperpigmentation. In most cases, the adverse effects are reversible and disappear after discontinuation of the drug. Although the dermatological complications usually do not influence the outcome of the therapy and rarely cause discontinuation of treatment, they have a great impact on patient quality of life.

Cylindroma transforming into basal cell carcinoma in a patient with Brooke-Spiegler syndrome

BACKGROUND Brooke-Spiegler syndrome is a rare condition with a predisposition to develop cutaneous adnexal neoplasms, especially cylindromas, trichoepitheliomas and spiradenomas. Malignant transformation of cylindromas is rare. In such cases usually cylindrocarcinomas develop within these lesions. We present an unusual case of basal cell carcinoma developing within a preexisting cylindroma. MAIN OBSERVATIONS 58-year-old woman with a 30-year history of multiple dermal cylindromas extensively involving her scalp was referred for dermatological treatment. The patient reported that one of the long-lasting lesions, 5.5 cm in size, ulcerated within the foregoing few weeks. Histopathology confirmed cylindromas and basal cell carcinoma within the ulcerating tumor. Surgical excision of largest cylindroma tumors led to cosmetic and functional improvement. Magnetic resonance and computed tomography showed tumor infiltration into the skull lamina externa. Metastases were excluded by chest radiography and abdominal ultrasound examination. CONCLUSION Patients with Brooke-Spiegler syndrome should be followed-up for malignant transformation of skin tumors to prevent deep penetration and possible metastases.

Hair Follicle Openings: Dots

The term dots refers to hair follicle openings seen from the perspective of a dermoscope. Black dots are residues of pigmented hairs broken or destroyed at scalp level. Yellow dots are follicular infundibula with keratotic material and/or sebum. Fibrotic white dots represent fibrosis in areas of selective follicular destruction. Pinpoint white dots are observed in patients with dark skin phototypes. They correspond to empty hair follicles or to the epidermal portion of eccrine sweat ducts. Red dots have been described in discoid lupus erythematosus. Pink to pink-brown dots are a characteristic finding in the eyebrow area of patients with frontal fibrosing alopecia.

Potential occupational and environmental factors in SSc onset

INTRODUCTION Introduction and objective. Systemic sclerosis [SSc; scleroderma] is a rare, connective tissue disorder affecting all organs and systems. The primary feature of this disease is a chronic, progressive fibrosis due to excessive production of collagen and other components. There are two subsets of systemic sclerosis: 1) diffused SSc (dSSc), 2) limited SSc (lSSc) and 3) scleroderma without sclerosis (SSSC). The presented review is an attempt to summarize recent data regarding environmental and occupational factors in SSc onset. STATE OF KNOWLEDGE There are many factors to be taken under consideration with SSc onset, although a strong correlation has been established for only a few. The most distinct factors are: crystalline silica and organic solvents (such as white spirit, aromatic, aliphatic-chain, chlorinated solvents, ketones, welding fumes). For other factors, which include abstestos, air pollution, other chemicals, silicone breast implants, tobacco smoking, drug reactions, diet influence and exposure to heavy metals, the jury is still out, and their position in SSc onset needs further studies. CONCLUSIONS Conclusions. Although the pathogenesis of scleroderma remains unclear, there is a marked correlation between the onset of SSc and certain environmental or occupational factors.

Vascular changes in autoimmunological connective tissue diseases

Vascular complications due to systemic connective tissue diseases pose a very difficult clinical problem. Due to the nature and location of the lesions, they very often prevent revascularization procedures and the conservative treatment is usually insufficient, which leads to a growth in the degree of ischemia and the need to amputate the limb. The authors clearly show the clinical picture of the most common diseases in this group — systemic lupus erythomatosus, systemic scleroderma, dermatomyositis, mixed connective tissue disease and Sjogren’s syndrome.

Stand-alone totally thoracoscopic left atrial appendage exclusion using a novel clipping system in patients with high risk of stroke – initial experience and literature review

Introduction Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and it is strongly associated with stroke. Left atrial appendage (LAA) is considered to be the most often source of thrombotic material. In recent decades a number surgical, percutaneous and hybrid approaches for LAA occlusion have been described revealing very different level of success and showing a variety of challenges associated with this matter. We present the first Polish experience with the stand-alone totally thoracoscopic LAA exclusion using novel clipping system. Material and methods Four patients (one male) in mean age of 74 (± 13) years with long-standing persistent and chronic AF were admitted for totally thoracoscopic LAA exclusion. All patients had significant comorbidities and the history of the oral anticoagulation intolerance or suboptimal/unstable level (CHA2DS2-VASC > 5, HAS_BLED > 3). Three procedures were performed through totally thoracoscopic access. In one patient due to massive adhesions in the left pleura we performed minithoracotomy in fourth left intercostal space. In two months follow-up we observed no mortality, no strokes and no bleedings. Results In all patient total exclusion of LAA with no residual remnant was confirmed. The “skin-to-skin” procedural time took on average 40, minimum 20 minutes. Patients were extubated directly or within two hours after procedure. All patients were discharged early in a good condition. Conclusions Our initial first experience with the novel totally thoracoscopic clipping system for stand-alone LAA exclusion is very promising showing very high efficacy and good safety profile.

Successful Intensification of Intravenous Rheological Treatment ofPhalanges Ischemia in SSc Patient Using Alprostadil

Systemic sclerosis (SSc) is a rare, auto immunological, connective tissue disease characterized by vasomotor disturbances, fibrosis and further atrophy of the skin and internal organs. There are many factors leading to immunological and vascular changes. One of the most prominent vascular symptoms is Raynaud’s phenomenon, which may be caused by different factors such as cold or excessive stress. This case report presents a 37- year old Caucasian woman with SSc, with severely impaired microcirculation of the hands and necrosis of the distal phalanges due to several hours of exposure to the cold. The patient required intensification of intravenous rheological treatment with alprostadil and oral usage of sildenafil, which had a positive effect on the improvement of the impaired microcirculation. Like many others, this case demonstrates that IV. rheological treatment may be effective in restoring microcirculation in such cases among SSc patients.

Raynaud’s phenomenon — the clinical picture, treatment and diagnostics

Raynaud’s phenomenon is the triphasic phenomenon which consists of sudden paling of distal parts of the body with the following cyanosis and occurance of erythema in the third stage. This phenomenon is a result of peripheral microcirculation disorder and usually appears after exposure to cold. If the RP is a primary, idiopathic (not associated with other diseases) then the other name for this condition is Raynaud’s disease (80% of RP cases). If the RP is secondary to other medical conditions such as connective tissue disorders, arterial alterations etc., then Raynaud’s syndrome is diagnosed and that is why further diagnostics is required in every case of RP.