14 research outputs found
The Pancreatitis, Panniculitis, and Polyarthritis (PPP) Syndrome: Subcutaneous Nodular Fat Necrosis, a Cutaneous Marker of Pancreatic Neoplasia
The pancreatitis, panniculitis, polyarthritis (PPP) syndrome
is a rare skin, joint, and pancreatic disorder, also known as subcutaneous
nodular fat necrosis. It results from obstruction of pancreatic ducts
with direct secretion of pancreatic enzymes into the bloodstream,
causing extra pancreatic fat necrosis with subcutaneous tissue and
joint inflammation. It is usually a cutaneous sign of pancreatic cancer
or pancreatitis. To our knowledge, this is the first case associated with
a pancreatic pseudotumor. We describe a 59-year-old man initially presenting
with numerous painful erythematous subcutaneous nodules
due to a fibrous pancreatic pseudotumor and its extreme dermatologic
disease, resulting in necrosis of the shin and foot so severe that an amputation
of the lower leg above the knee was required, a complication
not previously described, to our knowledge. We emphasize that PPP
syndrome is a cutaneous marker of internal malignancy, most often of
pancreatic cancer or pancreatitis, but in this case of a rare pancreatic
pseudotumor
Serum Concentration of Interleukin-6 Is Increased Both in Active and Remission Stages of Pemphigus Vulgaris
As most studies on pemphigus vulgaris (PV) pathogenesis concern its active stage, we aimed to evaluate the serum concentration of TNF-α, IL-1, and IL-6 in PV patients in clinical remission. The study group consisted of sera from 19 PV patients in active stage and from 24 patients in clinical remission. 19 sera taken from healthy subjects served as the controls. Serum IL-6 concentrations in PV active and PV remission group were significantly higher when compared to the controls (P < .05). In patients in active stage of PV, a significant correlation between serum IL-1 and IL-6 concentrations was found (rP = 0.46; P < .05). We also found a negative correlation between TNF-α level and pemphigus antibodies titer in the patients from the remission group (rS = −0.47303; P < .02). Our data suggest that IL-6 and TNF-α may be involved in maintaining immunological disturbances in remission stage of PV
The Imbalance in Serum Concentration of Th-1- and Th-2-Derived Chemokines as One of the Factors Involved in Pathogenesis of Atopic Dermatitis
Atopic dermatitis (AD) is an inflammatory skin
disease in which pathogenesis chemokines are
partially involved. The aim of the paper was to
assess the serum level of CXCL-9, CXCL-10, CXCL-11,
CXCL-12, CCL-17, CCL-20, CCL-21, CCL-22, CCL-27, and
IL-18 chosen in AD patients by ELISA assay. Forty
patients (mean age 11.4 years old) with AD and 50
healthy controls were enrolled into the study. The
patients and controls were divided into two age
categories: under 10 years old (Group 1 and Control 1)
and over 10 years old (Group 2 and Control 2).
Significantly lower serum concentration of CXCL-9,
CXCL-10, CCL-17, and IL-18 and higher concentration
of CXCL-12 and CCL-27 were found in Group 1 when
compared to Control 1. In Group 2 serum
concentration of CXCL-12, CCL-17, CCL-22 was higher
than in Control 2. The obtained results indicate the
imbalance in chemokine serum levels in AD what
suggests their role in the disease pathogenesis
Psychiatric disorders in patients with systemic lupus erythematosus: association of anxiety disorder with shorter disease duration
Physicians’ awareness about neuropsychiatric syndromes in systemic lupus erythematosus (SLE) is not rarely limited to seizures and psychoses included in the American College of Rheumatology (ACR) classification. Involvement of the central nervous system (CNS) with its rich symptomatology still belongs to the faintly recognised and understood aspects of lupus. The objective was to investigate prevalence and clinical correlations of psychiatric disorders in SLE patients. Fifty-two SLE patients were included. Disease duration and current and cumulative corticosteroid doses were calculated. Disease activity was assessed with the Systemic Lupus Activity Measure (SLAM). All subjects were examined by a psychiatrist. Psychiatric disorders were classified according to ACR criteria for neuropsychiatric systemic lupus erythematosus (NPSLE). Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) were used to screen for cognitive impairments. Mental disorders were diagnosed in 16 (30.77%), depressive disorder in 6 (11.54%), cognitive dysfunction in 5 (9.62%), anxiety disorder in 4 (7.69%) and psychosis in one patient (1.92%). SLE duration was shorter in patients diagnosed with anxiety disorder (P < 0.05), and cumulative dose of corticosteroids was lower in patients with anxiety disorder (P < 0.01). There was high positive correlation between SLE duration and cumulative dose of corticosteroids (r = 0.684, P < 0.001). Shorter SLE duration in patients with anxiety disorder seems to reflect its adaptative nature
Cognitive functions and autoantibodies in patients with systemic lupus erythematosus
Introduction: Autoantibodies may occur in the course of various diseases. In the case of systemic lupus erythematosus the
presence of specific autoantibodies is included in the classification criteria of the disease. The aim of the study was
to investigate whether the presence of the serologic markers of systemic lupus erythematosus, i.e. anti-dsDNA, anti-Sm and
anticardiolipin antibodies of the class IgM and IgG are linked with the results of neuropsychological tests evaluating selected
cognitive functions in patients without overt neuropsychiatric lupus and without antiphospholipid syndrome. Material and
methods: The study included 22 patients with systemic lupus erythematosus. For the assessment of anti-dsDNA, anti-Sm
and anticardiolipin antibodies the immunoenzymatic method was used. For neuropsychological estimation of the selected
cognitive functions the attention switching test and the choice reaction time were applied, in which the results are expressed
as the average delay i.e. mean correct latency, using the computer-based Cambridge Neuropsychological Test Automated
Battery (CANTAB). Results: The results of attention switching test in patients with anti-Sm antibodies were lower, but not
significantly different from those obtained by the patients without such antibodies: 75.0 (73.12–88.12) vs. 92.5 (85–95).
Choice reaction time was significantly longer in patients with anti-Sm antibodies in comparison to the patients without antiSm
antibodies: 614.9 (520.6–740.8) vs. 476.7 (396.6–540) (p = 0.01). No significant difference was demonstrated in the results
of attention switching test and choice reaction time with regard to the presence of anti-dsDNA antibodies. The results
of attention switching test and choice reaction time were not different between the groups of patients with and without
anticardiolipin antibodies in the IgM and IgG class. Conclusions: Anti-Sm antibodies seem to contribute to the pathogenetic
pathway involved in the deterioration of the results of the selected cognitive functions in systemic lupus erythematosus
patients. The use of neuropsychological assessment as a screening procedure in systemic lupus erythematosus patients with anti-Sm antibodies appears to be reasonable
Funkcje poznawcze a autoprzeciwciała u chorych na toczeń rumieniowaty układowy
Introduction: Autoantibodies may occur in the course of various diseases. In the case of systemic lupus erythematosus the presence of specific autoantibodies is included in the classification criteria of the disease. The aim of the study was to investigate whether the presence of the serologic markers of systemic lupus erythematosus, i.e. anti-dsDNA, anti-Sm and anticardiolipin antibodies of the class IgM and IgG are linked with the results of neuropsychological tests evaluating selected cognitive functions in patients without overt neuropsychiatric lupus and without antiphospholipid syndrome. Material and methods: The study included 22 patients with systemic lupus erythematosus. For the assessment of anti-dsDNA, anti-Sm and anticardiolipin antibodies the immunoenzymatic method was used. For neuropsychological estimation of the selected cognitive functions the attention switching test and the choice reaction time were applied, in which the results are expressed as the average delay i.e. mean correct latency, using the computer-based Cambridge Neuropsychological Test Automated Battery (CANTAB). Results: The results of attention switching test in patients with anti-Sm antibodies were lower, but not significantly different from those obtained by the patients without such antibodies: 75.0 (73.12–88.12) vs. 92.5 (85–95). Choice reaction time was significantly longer in patients with anti-Sm antibodies in comparison to the patients without anti- Sm antibodies: 614.9 (520.6–740.8) vs. 476.7 (396.6–540) (p = 0.01). No significant difference was demonstrated in the results of attention switching test and choice reaction time with regard to the presence of anti-dsDNA antibodies. The results of attention switching test and choice reaction time were not different between the groups of patients with and without anticardiolipin antibodies in the IgM and IgG class. Conclusions: Anti-Sm antibodies seem to contribute to the pathogenetic pathway involved in the deterioration of the results of the selected cognitive functions in systemic lupus erythematosus patients. The use of neuropsychological assessment as a screening procedure in systemic lupus erythematosus patients with anti-Sm antibodies appears to be reasonable.Wprowadzenie: Autoprzeciwciała mogą występować w przebiegu różnych chorób. W przypadku tocznia rumieniowatego układowego obecność określonych autoprzeciwciał stanowi jedno z kryteriów klasyfikacyjnych choroby. Celem pracy było wykazanie, czy obecność serologicznych markerów tocznia rumieniowatego układowego, tj. autoprzeciwciał anty-dsDNA, anty-Sm oraz przeciwciał antykardiolipinowych klasy IgM i IgG, jest związana z wynikami testów neuropsychologicznych, oceniających wybrane funkcje poznawcze u pacjentów bez objawów tocznia neuropsychiatrycznego i bez zespołu antyfosfolipidowego. Materiał i metody: Badaniem objęto 22 chorych na toczeń rumieniowaty układowy. W badaniu przeciwciał anty-dsDNA, anty-Sm i przeciwkardiolipinowych wykorzystano metodę immunoenzymatyczną. Do oceny neuropsychologicznej wybranych funkcji poznawczych użyto testu przełączania uwagi i czasu reakcji wyboru, w którym wyniki są wyrażone jako średnie opóźnienie; wykorzystano komputerowy zestaw Cambridge Neuropsychological Test Automated Battery (CANTAB). Wyniki: Wyniki testu przełączania uwagi u pacjentów z przeciwciałami anty-Sm były niższe, ale nie różniły się znacząco od tych uzyskanych przez pacjentów bez tych przeciwciał: 75,0 (73,12–88,12) vs 92,5 (85–95). Czas reakcji wyboru był istotnie dłuższy u chorych na toczeń rumieniowaty układowy z przeciwciałami anty-Sm w porównaniu z pacjentami bez tych przeciwciał: 614,9 (520,6–740,8) vs 476,7 (396,6–540) (p = 0,01). Nie wykazano istotnej różnicy w wynikach testu przełączania uwagi i czasu reakcji wyboru w zależności od występowania przeciwciał anty-dsDNA i przeciwciał przeciwkardiolipinowych klasy M i G. Wnioski: Przeciwciała anty-Sm wydają się przyczyniać do łańcucha patogenetycznego związanego z pogorszeniem wyników wybranych funkcji poznawczych u chorych na toczeń rumieniowaty układowy. Uzasadnione wydaje się przesiewowe zastosowanie badania neuropsychologicznego u chorych na toczeń rumieniowaty układowy z występującymi przeciwciałami anty-Sm
Original paper Contact allergy in the population of patients with chronic inflammatory dermatoses and contact hypersensitivity to corticosteroids
A b s t r a c t Introduction: Clinical studies indicate that contact allergy to glucocorticosteroids (GCS) is not rare and has been increasingly reported over the past decade. Among the risk factors for developing contact hypersensitivity to topical corticosteroids, chronic inflammatory skin diseases and polyvalent contact allergy seem to be most important. Aim: To present the structure of contact allergy in the population of patients with chronic inflammatory dermatoses (CID) and contact hypersensitivity to corticosteroids. Material and methods: Twenty-seven patients with contact allergy to GCS and chronic inflammatory dermatoses were patch tested with 28 European Baseline Series allergens and 8 corticosteroid allergens. This study group consisted of 5 patients with atopic dermatitis (AD), 15 patients with contact eczema (CE) and 7 with chronic leg eczema (CLE). Nineteen (70.4%) patients were females and 8 (29.6%) were males. Results: In the study group, the most sensitizing non-steroidal allergens were nickel sulfate (51.8%), cobalt chloride (33.3%) and balsam of Peru (29.6%). The most sensitizing corticosteroid allergens were budesonide (77.8%), betamethasone valerate and clobetasol propionate (55.5% each). A total of 77.8% of patients allergic to GCS also showed sensitivity to at least one non-steroidal allergen from the European Baseline Series. Conclusions: The most important risk factors for developing contact allergy to corticosteroids appear to be chronic inflammatory dermatoses, long disease duration, extended on-and-off topical corticosteroid use, patients presenting two or more positive patch test results and polyvalent contact allergy to metal salts and to other non-steroidal haptens
Badanie zależności pomiędzy funkcjami poznawczymi oraz stanem układu sercowo-naczyniowego u chorych na toczeń rumieniowaty układowy bez objawów neuropsychiatrycznych
The aim: To investigate relations between selected neurocognitive parameters and echocardiographic variables in patients with systemic lupus erythematosus. Material and methods: The study included 24 female patients with systemic lupus erythematosus. In the neuropsychological assessment, the Cambridge Neuropsychological Test Automated Battery (CANTAB) was performed, using the following tests: Motor Screening Task, Big/Little Circle, Paired Associates Learning, Stockings of Cambridge and Graded Naming Test. A decrease in the cognitive function was defined as the value of results below two standard deviations. The function of the heart was examined with transthoracic echocardiography. The diastolic function of the left ventricle was estimated with the ratio of early to late ventricular filling velocities. Results: In 8.3% of patients, Mean Latency (Motor Screening Task) was lower than standard zero, whereas Mean Errors (Motor Screening Task) remained above the cut-off level. Paired Associates Learning, Subsequent Thinking Mean Time (Stockings of Cambridge), Problems Solved in Minimum Moves (Stockings of Cambridge) and Graded Naming Test were found to be lower than standard zero in 79.16%, 26.08%, 70.83%, and 87.5% of patients, respectively. Mean Initial Thinking Time (Stockings of Cambridge) was above the cut-off level. When the cut-off level was defined as results below two standard deviations from standard zero, a reduction in cognitive functions was found in 4% of patients in Paired Associates Learning and Graded Naming Test, and in 1% of patients in Mean Subsequent Thinking Time (Stockings of Cambridge) and Problems Solved in Minimum Moves (Stockings of Cambridge). Mean Latency (Motor Screening Task), Mean Errors (Motor Screening Task), Big/Little Circle, and Mean Initial Thinking Time (Stockings of Cambridge) remained above the cut-off level. Based on the evaluation of ejection fraction, no patient showed signs of systolic dysfunction of the left ventricle, defined as ejection fraction <55%. There was no correlation between the ejection fraction and the results obtained in those CANTAB tests which were lower than two standard deviations. The ratio of early and late ventricular filling velocities showed no correlation with the results of Paired Associates Learning, Stockings of Cambridge, and Graded Naming Test. Conclusions: A decrease in selected cognitive functions in patients with systemic lupus erythematosus, examined with CANTAB and demonstrated by the results of Paired Associates Learning, Graded Naming Test, Mean Subsequent Thinking Time and Problems Solved in Minimum Moves in Stockings of Cambridge, may be present without any features of the heart failure.Cel: Zbadanie zależności pomiędzy poziomem wybranych funkcji poznawczych a zmiennymi echokardiograficznymi u pacjentów z toczniem rumieniowatym układowym. Materiał i metody: Badaniem objęto 24 pacjentki z toczniem rumieniowatym układowym. Do oceny neuropsychologicznej wykorzystano testy metody Cambridge Neuropsychological Test Automated Battery (CANTAB): Motor Screening Task, Big/Little Circle, Paired Associates Learning, Stockings of Cambridge i Graded Naming Test. Za próg spadku poziomu funkcji poznawczych przyjęto dwa odchylenia standardowe. Funkcje serca badano przy użyciu transtorakalnej echokardiografii. Czynność rozkurczową lewej komory oceniano, wykorzystując iloraz prędkości wczesnego i późnego napływu mitralnego. Wyniki: U 8,3% pacjentów wynik uzyskany w Mean Latency (Motor Screening Task) był niższy niż standardowe zero, podczas gdy wynik Mean Errors (Motor Screening Task) pozostał powyżej standardowego zera. Wyniki uzyskane w testach: Paired Associates Learning, Subsequent Thinking Mean Time (Stockings of Cambridge), Problems Solved in Minimum Moves (Stockings of Cambridge) i Graded Naming Test okazały się niższe od standardowego zera odpowiednio w 79,16%, 26,08%, 70,83% i 87,5% pacjentów. Wartość Mean Initial Thinking Time (Stockings of Cambridge) była powyżej standardowego zera. Obniżenie funkcji poznawczych (dwa odchylenia poniżej standardowego zera) stwierdzono u 4% pacjentów w Paired Associates Learning oraz Graded Naming Test, a u 1% pacjentów w Subsequent Thinking Mean Time (Stockings of Cambridge) i Problems Solved in Minimum Moves (Stockings of Cambridge). Z kolei wyniki uzyskane w Mean Latency (Motor Screening Task), Mean Errors (Motor Screening Task), Big/Little Circle oraz Mean Initial Thinking Time (Stockings of Cambridge) pozostały powyżej standardowego zera. Żaden pacjent nie wykazał objawów dysfunkcji skurczowej lewej komory serca, definiowanej jako frakcja wyrzutowa <55%. Nie stwierdzono korelacji pomiędzy frakcją wyrzutową i wynikami uzyskanymi w tych badaniach CANTAB, które były niższe niż dwa odchylenia standardowe. Nie wykazano korelacji pomiędzy wczesną i późną komorową prędkością napełnień a wynikami Paired Associates Learning, Stockings of Cambridge oraz Graded Naming Test. Wnioski: Spadek wybranych funkcji poznawczych u pacjentów z toczniem rumieniowatym układowym badanych metodą CANTAB oraz przedstawianych w postaci wyników w testach Paired Associates Learning, Graded Naming Test, Mean Subsequent Thinking Time i Problems Solved in Minimum Moves (Stockings of Cambridge) może wystąpić bez cech niewydolności serca
The examination of the relationship between cognitive functions and cardiovascular condition in systemic lupus erythematosus patients without obvious neuropsychiatric features
The aim: To investigate relations between selected neurocognitive parameters and echocardiographic variables in patients
with systemic lupus erythematosus. Material and methods: The study included 24 female patients with systemic lupus
erythematosus. In the neuropsychological assessment, the Cambridge Neuropsychological Test Automated Battery
(CANTAB) was performed, using the following tests: Motor Screening Task, Big/Little Circle, Paired Associates Learning,
Stockings of Cambridge and Graded Naming Test. A decrease in the cognitive function was defined as the value of results
below two standard deviations. The function of the heart was examined with transthoracic echocardiography. The diastolic
function of the left ventricle was estimated with the ratio of early to late ventricular filling velocities. Results: In 8.3%
of patients, Mean Latency (Motor Screening Task) was lower than standard zero, whereas Mean Errors (Motor Screening
Task) remained above the cut-off level. Paired Associates Learning, Subsequent Thinking Mean Time (Stockings
of Cambridge), Problems Solved in Minimum Moves (Stockings of Cambridge) and Graded Naming Test were found to be
lower than standard zero in 79.16%, 26.08%, 70.83%, and 87.5% of patients, respectively. Mean Initial Thinking Time
(Stockings of Cambridge) was above the cut-off level. When the cut-off level was defined as results below two standard
deviations from standard zero, a reduction in cognitive functions was found in 4% of patients in Paired Associates Learning
and Graded Naming Test, and in 1% of patients in Mean Subsequent Thinking Time (Stockings of Cambridge) and Problems Solved in Minimum Moves (Stockings of Cambridge). Mean Latency (Motor Screening Task), Mean Errors (Motor Screening Task), Big/Little Circle, and Mean Initial Thinking Time (Stockings of Cambridge) remained above the cut-off level. Based
on the evaluation of ejection fraction, no patient showed signs of systolic dysfunction of the left ventricle, defined as ejection
fraction <55%. There was no correlation between the ejection fraction and the results obtained in those CANTAB tests which
were lower than two standard deviations. The ratio of early and late ventricular filling velocities showed no correlation with
the results of Paired Associates Learning, Stockings of Cambridge, and Graded Naming Test. Conclusions: A decrease in selected cognitive functions in patients with systemic lupus erythematosus, examined with CANTAB and demonstrated by
the results of Paired Associates Learning, Graded Naming Test, Mean Subsequent Thinking Time and Problems Solved in
Minimum Moves in Stockings of Cambridge, may be present without any features of the heart failure
Role of vitamin D3 in pathogenesis of psychiatric disorders
Through many years vitamin D was considered to be responsible for maintaining calcium-phosphorus homeostasis and bone metabolism. From 20 years it is known that this is not the only role vitamin D plays in an organism. The target tissues responds for active form of calcitriol by neuroprotection, immunomodulation and detoxification. “Sunshine vitamin” reduces the risk for a variety of diseases including type I diabetes, sclerosis multiplex, rheumatoid arthritis, cancer. Vitamin D acts through the VDR receptors located in many organs: bones, skeletal muscles, immune cells, and several body tissues, including the brain. Calcium homeostasis and neurotrophins synthesis is a neuroprotective activity of vitamin D. According to many researchers vitamin D plays an important role in the brain functioning and development. It is also believed that deficiency in microelements may impair brain functioning. Thus cognitive function improves when microelements and vitamins supply is sufficient. Biological activities suggest vitamin D can influence appearing depressive disorders and cognitive functions. Vitamin D supplementation can influence the development of autoimmune diseases, rheumatoid diseases and others. Supplementation with high doses of vitamin D seems to ameliorate depressive symptoms indicating a possible causal relationship.Witaminę D od zawsze uważano za czynnik odpowiedzialny za utrzymanie gospodarki wapniowo-fosforanowej w organizmie oraz strukturę kośćca. Od około 20 lat wiadomo, że witamina ta odgrywa w ustroju nie tylko tę rolę. Badania prowadzone w ostatnich latach wskazują na szeroki zakres jej oddziaływań na ludzki organizm. Dowiedziono, że organy docelowe odpowiadają na aktywny metabolit witaminy D poprzez działanie neuroprotekcyjne, immunomodulacyjne, detoksykacyjne i antyproliferacyjne. W związku z tym „słoneczna witamina” powoduje obniżenie ryzyka rozwoju wielu chorób, takich jak: cukrzyca typu I, stwardnienie rozsiane, reumatoidalne zapalenie stawów, rak. Witamina D działa poprzez jej receptory VDR, które zlokalizowane są w wielu narządach: kościach, mięśniach szkieletowych, komórkach układu immunologicznego, a także w mózgu. Działanie neuroprotekcyjne witaminy D przejawia się poprzez regulację homeostazy wapnia i syntezę neurotropin. Autorzy wielu prac wskazują na udział tej witaminy w rozwoju i funkcjonowaniu mózgu, na pogorszenie pracy mózgu przy nieprawidłowym jego zaopatrzeniu w mikroelementy oraz na poprawę funkcji poznawczych u osób, u których stężenie witamin i mikroelementów jest prawidłowe. Biologiczne działania sugerują, że witamina D może wpływać na występowanie objawów depresji oraz na funkcje poznawcze. Istnieją prace potwierdzające korzystny wpływ suplementacji witaminy D na choroby autoimmunologiczne, reumatologiczne i inne. Pojedyncze prace przeprowadzone na niewielkich grupach pacjentów także dowodzą wpływu suplementacji na poprawę kliniczną pacjentów z objawami depresji