Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

VIPoma and PPoma

Gastrinomas are rare tumors of the neuroendocrine system, occurring within the pancreas and duodenum. The annual incidence is estimated at 0.5 per million of the population [1]. Overproduction of gastrin by these tumors produces a sustained increase in gastric acid secretion, leading to clinical manifestations of complicated peptic ulcer disease known as the Zollinger-Ellison syndrome (ZES) [2]. Although most gastrinomas grow slowly, over 60 % are malignant and 25 % show rapid aggressive behavior [3-5]. Most commonly gastrinomas metastasize to regional lymph nodes and the liver, and it is this malignant potential which has become increasingly important since the introduction of effective medical therapy to control gastric acid secretion. Gastrinomas can occur sporadically or in a familial pattern as a component of the multiple endocrine neoplasia type 1 (MEN1) syndrome [3, 6, 7]. Given that the endocrinopathy associated with these tumors can be well controlled medically, the role of surgical resection in the setting of advanced disease and in patients with MEN1 syndrome is the subject of continued debate