DEER KED (LIPOPTENA CERVI) DERMATITIS IN HUMANS – AN INCREASING NUISANCE IN FINLAND

The deer ked (Lipoptena cervi) is a haematophagous ectoparasite of moose (Alces alces) and other cervids that commonly bites humans in Finland. Since the 1970s there has been an increasing number of Finns who suffer from long-lasting and recurrent dermatitis associated with deer ked bites. Forestry workers, hunters, berry and mushroom pickers, and other people who work in or visit forests during late summer and early autumn are especially vulnerable to incidental deer ked infestation and dermatitis. Interestingly, negative effects of deer keds on human activities have not been recently reported in countries other than Finland. Our work indicates that dermatitis caused by deer keds consists of a few to 20-50 red papules which occur mostly on the scalp, neck, and upper back. The papules usually appear 6-24 h after the bites and size varies from a few mm to 1-2 cm. They can persist several weeks and in some people up to 1 year. The rapid range expansion of the deer ked in 1970-1990s seems related to the concurrent increase in moose population density in Finland. It is possible that range expansion of the deer ked will be promoted by high densities of semi-domesticated reindeer (Rangifer tarandus tarandus) in northern Finland. As a result, we predict an increase in the distribution of deer keds and the number of people with deer ked dermatitis requiring medical treatment in Finland

Differential diagnosis and long-term outcomes of non-atrophic duodenal changes in children

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DEER KED (LIPOPTENA CERVI) DERMATITIS IN HUMANS – AN INCREASING NUISANCE IN FINLAND

The deer ked (Lipoptena cervi) is a haematophagous ectoparasite of moose (Alces alces) and other cervids that commonly bites humans in Finland. Since the 1970s there has been an increasing number of Finns who suffer from long-lasting and recurrent dermatitis associated with deer ked bites. Forestry workers, hunters, berry and mushroom pickers, and other people who work in or visit forests during late summer and early autumn are especially vulnerable to incidental deer ked infestation and dermatitis. Interestingly, negative effects of deer keds on human activities have not been recently reported in countries other than Finland. Our work indicates that dermatitis caused by deer keds consists of a few to 20-50 red papules which occur mostly on the scalp, neck, and upper back. The papules usually appear 6-24 h after the bites and size varies from a few mm to 1-2 cm. They can persist several weeks and in some people up to 1 year. The rapid range expansion of the deer ked in 1970-1990s seems related to the concurrent increase in moose population density in Finland. It is possible that range expansion of the deer ked will be promoted by high densities of semi-domesticated reindeer (Rangifer tarandus tarandus) in northern Finland. As a result, we predict an increase in the distribution of deer keds and the number of people with deer ked dermatitis requiring medical treatment in Finland

Insulinoomat Tampereen yliopistollisen sairaalan erityisvastuualueella 1980-2010

METHODS: Retrospective analysis of insulinomas diagnosed in Tampere University Hospital. RESULTS: We found 23 iNET cases corresponding to an incidence of 0.7/million/year. All had neuroglycopenic symptoms and 83% had autonomic ones. The median diagnostic delay (from first symptoms up to diagnosis) was 25 months. Preoperative imaging found the tumor in 87%. Twenty-one out of 22 patients who underwent surgery recovered completely. CONCLUSIONS: Despite improved imaging the diagnostic delay of iNETs remained unchanged. Hypoglycemia and insulinoma should be considered as a cause of unspecific, symptomatic attacks

Prevalence and diagnostic outcomes of children with duodenal lesions and negative celiac serology

Background: Celiac disease diagnostics begin by measuring autoantibodies, which may fail to identify seronegative patients. Duodenal lesion in the absence of antibodies is scarcely studied, especially in children. Aims: To investigate the prevalence and diagnostic outcomes of children with seronegative duodenal lesion in two countries with different disease profiles. Methods: Medical data, including the results of histology and transglutaminase (tTGab) and endomysium (EmA) antibody measurements were collected from 1172 Finnish and 264 Romanian children with systematic duodenal sampling. Database of 509 Finnish children with celiac disease was examined to identify earlier seronegative patients. Results: Celiac disease was diagnosed in 307 Finnish and 83 Romanian children in the endoscopy cohorts. No seronegative patients were found among 899 celiac disease patients, although some were only tTGab or EmA positive. Non-celiac duodenal lesion was detected in eight Finnish and 32 Romanian children, their most common diagnoses being inflammatory bowel disease and infections, respectively. Six children with morphological lesion received no diagnosis. None of them developed celiac disease during a follow-up of 3-11 years. Conclusion: Pediatric seronegative celiac disease is exceptional in the era of modern autoantibodies. Other reasons for duodenal lesion should therefore be sought, bearing in mind possible differences across countries. (C) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.Peer reviewe

R-Bendamustine in the treatment of nodular lymphocyte-predominant Hodgkin lymphoma

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Dermatitis Herpetiformis Refractory to Gluten-free Dietary Treatment

Dermatitis herpetiformis (DH) is a blistering skin disease, which is regarded as an extra-intestinal manifestation of coeliac disease. Refractory cases of coeliac disease, that do not respond to a gluten-free diet and which carry an increased risk of lymphoma, are well-known in coeliac disease. To determine whether refractory cases of DH with active rash and persistent small bowel atrophy occur we analysed our series of 403 patients with DH. Seven (1.7%) patients, who had been on a gluten-free diet for a mean of 16 years, but who still required dapsone to treat the symptoms of DH, were identified. Of these, one patient died from mucinous adenocarcinoma before re-examination. At re-examination skin immunoglobulin A (IgA) deposits were found in 5/6 refractory and 3/16 control DH patients with good dietary response. Small bowel mucosa was studied at re-examination from 5 refractory and 8 control DH patients and was normal in all 5 refractory and 7/8 control DH patients. One refractory DH patient died from adenocarcinoma, but no lymphoma developed in any of the patients. This study documents for the first time refractory DH, in which the rash is non-responsive to a gluten-free diet, but the small bowel mucosa heals. This differs from refractory coeliac disease, in which the small bowel mucosa does not heal on a gluten-free diet.Peer reviewe

Characteristics and Outcomes of 79 Patients with an Insulinoma : A Nationwide Retrospective Study in Finland

Objective. Insulinomas are rare pancreatic tumours. Population-based data on their incidence, clinical picture, diagnosis, and treatment are almost nonexistent. The aim of this study was to clarify these aspects in a nationwide cohort of insulinoma patients diagnosed during three decades. Design and Methods. Retrospective analysis on all adult patients diagnosed with insulinoma in Finland during 1980-2010. Results. Seventy-nine patients were diagnosed with insulinoma over the research period. The median follow-up from diagnosis to last control visit was one (min 0, max 31) year. The incidence increased from 0.5/million/year in the 1980s to 0.9/million/year in the 2000s (p = 0 002). The median diagnostic delay was 13 months and did not change over the study period. The mean age at diagnosis was 52 (SD 16) years. The overall imaging sensitivity improved from 39% in the 1980s to 98% in the 2000s (p <0 001). Seventy- one (90%) of the patients underwent surgery with a curative aim, two (3%) had palliative surgery, and 6 (8%) were inoperable. There were no significant differences in the types of surgical procedures between the 1980s, 1990s, and 2000s; tumour enucleations comprised 43% of the operations, distal pancreatic resections 45%, and pancreaticoduodenectomies 12%, over the whole study period. Of the patients who underwent surgery with a curative aim, 89% had a full recovery. Postoperative complications occurred in half of the patients, but postoperative mortality was rare. Conclusions. The incidence of insulinomas has increased during the past three decades. Despite the improved diagnostic options, diagnostic delay has remained unchanged. To shorten the delay, clinicians should be informed and alert to consider the possibility of hypoglycemia and insulinoma, when symptomatic attacks are investigated in different sectors of the healthcare system. Developing the surgical treatment is another major target, in order to lower the overall complication rate, without compromising the high cure rate of insulinomas.Peer reviewe