Adult onset still's disease and prurigo pigmentosa: an unusual association and review of literature

This study was conducted in the Department of Medicine, Department of Dermatology, Al-Adan Hospital, Ministry of Health-Kuwait. This patient was hospitalized as a case of pyrexia of unknown origin. We report atypical skin eruption in this patient who fulfilled the criteria for Adult Onset Still's Disease [AOSD] despite the absence of the typical still's rash. Skin biopsy revealed prurigo pigmentosa [PP]. To elucidate this unusual association, we searched the literature for the cutaneous manifestations of AOSD. Kahori T, et al had described PP like lesions in a patient with AOSD in addition to the typical still's rash and it is the only case report that exists in English literature. In our case, except for still's rash, all the criteria of AOSD were present, the diagnosis was made after excluding all other possible causes i.e. infectious diseases, other rheumatic diseases, vasculitis and malignant disease. The objective for reporting this case and review of literature is to shed more light on the rare dermatological disorder Prurigo Pigmentosa [PP] and its unusual association with Adult Onset Still's Disease [AOSD]. Clinicians and dermatologist must be aware of this unusual association of PP and AOSD as the diagnosis of AOSD can be made in the absence of the typical still's rash but in the presence of other atypical cutaneous manifestations including PP

first postoperative year results of transthoracic Ivor-Lewis esophagectomy with stapled intrathoracic esophagogastric anastomosis for treatment of lower esophageal cancer

Esophageal cancer represents one of the most lethal malignancies affecting mankind. This is compounded by the fact that adenocarcinoma of the esophagus is increasing in incidence at a rate exceeding that of any other neoplasm. At most centers, esophageal resection remains the therapeutic alternative of choice for patients who are considered to be surgical candidates. The surgeons' opinions about Ivor Lewis operation has long been sceptic because of the consequences if leakage of the intra thoracic anastomosis occurred. However, with the advent of stapling devices and with the advances in operative techniques, a well vascularized oesophageal substitute can be prepared and a safe anastomosis can be constructed. In the present work, we managed 17 patients with carcinoma of the lower oesophagus by Ivor-Lewis subtotal esophagectomy with 2 field lymphadenectomy from May 2000 to July 2004. We used the stomach as an oesophageal substitute and a stapled oesophagogastric anastomosis was done at the apex of thorax. The median ICU stay was 2 days [1-38 days] and the median postoperative stay for those patients without complication was 14 days. The proximal longitudinal resection margin was infiltrated in 1 case while 3 cases showed involvement of the circumferential margin. Primary pulmonary complication occurred in 6 patients with 1 related mortality. Leakage occurred in 4 patients, 3 among them were managed conservatively. Three patients died postoperatively [17.6% with only one case died from surgical rather than medical complication], one from acute respiratory distress syndrome, second from profound sepsis following extensive mediastinal leakage and third one from massive myocardial infarction. At the end of the 1[st] postoperative year, 10 patients were alive. It has been concluded that Ivor Lewis operation is a good option for patients with carcinoma of the lower oesophagus and a better outcome depends on early recognition and aggressive management of complications that can minimize subsequent mortality