Severe eosinophilic fasciitis: comparison of treatment with D-penicillamine plus corticosteroids vs. corticosteroids alone.

OBJECTIVES: To compare the therapeutic effectiveness of corticosteroids (CS) alone vs. CS plus d-penicillamine (d-Pen) in severe eosinophilic fasciitis. METHOD: A long-term prospective non-randomized trial of d-Pen plus CS vs. CS alone in patients with severe eosinophilic fasciitis, defined as clinically apparent cutaneous fibrotic involvement affecting more than 15% body surface area (BSA) or more than 10% BSA with joint flexion contractures. RESULTS: Sixteen patients with severe eosinophilic fasciitis entered the study. Ten patients received d-Pen plus CS and six received CS alone. Affected BSA decreased from an average of 29% to 8.9% in the d-Pen plus CS group compared to a decrease in affected BSA from 28% to 22.83% in the CS-alone group. The reduction in affected BSA in the d-Pen plus CS group was significantly greater than in the CS-alone group (p = 0.038). Clinical improvement occurred in all d-Pen plus CS patients compared to only 33.3% of CS-alone patients (p = 0.008). There was no difference in overall frequency of adverse events between the groups (p = 0.60). The most common adverse event in the d-Pen plus CS group was proteinuria (33.3%). However, proteinuria also occurred in 16.6% in the CS-alone group. CONCLUSIONS: Treatment with CS alone failed to induce clinical improvement in the majority of the severe eosinophilic fasciitis patients. By contrast, d-Pen plus CS resulted in significantly greater clinical improvement. These results suggest that initial treatment of severe eosinophilic fasciitis with CS alone is not sufficient for optimal therapeutic response and that addition of an antifibrotic agent results in an improved outcome.

Comparison of Prostatic Volume Measured with Abdominal Ultrasound and Prostatic Weight Determined after Open Enucleation Performed in Gondar University Hospital; Ethiopia

Objective: To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Patients and Methods: Between April 2002 and October 2006; 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department; Cairo; Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type; stage; grade and gross features in addition to lymph node involvement were particularly noted. Results: Bilharzial bladder pathology (lesions or ova) was present in 105 (70.9) of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma (TCC) in 84 (56.7); squamous cell carcinoma (SCC) in 51 (34.5); adenocarcinoma in 9 (6.1) and anaplastic tumor in 4 (2.7) of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23; pT3 in 70.9and pT4a involving the prostate or seminal vesicles in 6.1. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 (48.6) and high grade in 76 (51.4) specimens. Regional lymph node involvement was detected in 31 (20.9) specimens irrespective of bilharzial infestation. Conclusion: Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3; low-grade SCC and commonly appears as an ulcerative; bulky; fungating or verrucous mass. On the other hand; bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation