A rare case of adult scalp pyoderma gangrenosum with cranial osteolysis.

Pyoderma gangrenosum (PG) is a rare and painful idiopathic skin condition that has one or more areas of chronic ulceration with well demarcated and undermined borders. Bone osteolysis (the pathological destruction of bone tissue) secondary to PG is a rare phenomenon with limited cases reported in children only. This is the first case report of scalp PG with cranial osteolysis in an 80-year-old adult, with an initial presentation mimicking skin carcinoma. This case highlights the importance of a multidisciplinary team (MDT) meeting discussion, diagnosis of PG by exclusion and the successful treatment of this patient's PG eroding to the bone.

The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer.

AIM: To date, there is no uniform consensus on whether tumour regression grade (TRG) is predictive of outcome in rectal cancer. Furthermore, the lack of standardization of TRG grading is a major source of variability in published studies. The aim of this study was to evaluate the prognostic impact of TRG in a cohort of patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation therapy (CRT). In addition to the Mandard TRG, we utilized four TRG systems modified from the Mandard TRG system and applied them to the cohort to assess which TRG system is most informative. METHOD: One-hundred and fifty-three patients with a T3/T4 and/or a node-positive rectal cancer underwent neoadjuvant 5-fluorouracil-based CRT followed by surgical resection. RESULTS: Thirty-six (23.5%) patients achieving complete pathological response (ypCR) had a 5-year disease-free survival (DFS) rate of 100% compared with a DFS rate of 74% for 117 (76.5%) patients without ypCR (P = 0.003). The Royal College of Pathologists (RCPath) TRG best condenses the Mandard five-point TRG by stratifying patients into three groups with distinct 5-year DFS rates of 100%, 86% and 67%, respectively (P = 0.001). In multivariate analysis, pathological nodal status and circumferential resection margin (CRM) status, but not TRG, remained significant predictors of DFS (P = 0.002, P = 0.035 and P = 0.310, respectively). CONCLUSION: Our findings support the notion that ypCR status, nodal status after neoadjuvant CRT and CRM status, but not TRG, are predictors of long-term survival in patients with locally advanced rectal cancer.

IgA deposition in the skin of patients with alcoholic liver disease.

In patients with alcoholic liver disease, IgA deposits are often found in the liver, kidneys and skin. The present study was undertaken to determine the specificity, sensitivity and characteristics of IgA deposition in the skin of a group of alcoholic patients with or without overt liver disease, and compare these with findings in non-alcoholic cirrhotics. Twenty-six out of 28 patients with alcoholic cirrhosis had IgA deposition in the skin. In contrast, only 6 out of 11 patients who were alcoholic without any clinical liver disease and 3 out of 13 patients with non-alcoholic cirrhosis of the liver had IgA deposition. In the control group, only 1 out of 52 patients with various dermatoses (excluding IgA dermatoses) had this IgA deposition. Unlike other IgA dermatoses, such as Henoch-Schoenlein purpura or dermatitis herpetiformis, IgA deposition in alcoholic liver disease is characterized by its presence in the basement membrane of the eccrine secretory coils. This particular pattern of IgA deposition can be helpful in the diagnosis of alcoholic liver disease or alcoholism since the specificity is 100% with a sensitivity of 75%.

Evaluation of nutritional status and its effects on morbidity and mortality of surgical patients.

Sixtynine patients (31 males and 38 females) above the age of 12 years undergoing surgery under general anaesthesia were selected for this study. Thirty percent males and 29% females were depleted, 55% and 37% males and females, respectively, were normal and 13% and 34% males and females, respectively, were obese as indicated by Body-mass index (BMI). Measurement of midarm-muscle-circumference (MAMC) indicated mild to moderate protein deficiency in 32% of the patients while triceps skinfold thickness (T.S.T) indicates mild to severe calorie deficiency in 68% males and 50% females. Dietary intake both pre and post operatively was unsatisfactory. Pre-operatively 26% of the females had Hb level below normal (less than 11 G%). Only 3-5% of the patients had protein and albumin level below normal (less than 3.5 G%). Post-operatively all the anthropometric measurements as well as serum protein and albumin levels decreased and BUN increased significantly indicating body catabolism. Post operative hospital stay was significantly more in undernourished patients.