Medical Inspection – Health Blog

Patients with neuromuscular respiratory insuffi­ciency or restrictive lung disease from thoracic wall deformity may present with subtle symptoms and signs of nocturnal respiratory insufficiency which may not be recognized until the patient develops severe respiratory distress or signs of cor pulmonale. There is increasing interest in the use of noninvasive methods as alternatives to TIPPV for management of these patients. Avoidance of tracheostomy facilitates the use of GPB for those who can master this technique.

Read More…

Brinzolamide and dorzolamide are highly specific topical CAIs, which lower intraocular pressure (IOP) by reducing the rate of aqueous humour formation. Although systemic CAIs are the most potent medications for lowering intraocular pressure for primary open-angle glaucoma and other con­ditions with ocular hypertension, many cases with adverse systemic reactions have been reported, including Stevens-Johnson syndrome (SJS), TEN, fulminant hepatic necrosis, aplastic anemia, drug hypersensitivity, metabolic acidosis, serum sickness and nephritis. Therefore, topical application of intraopthalmic CAIs is recommended to control intrao­cular pressure, as this route of administration lowers ocular hypertension without serious adverse reactions.

Read More…

Case 1

A 45-year-old Korean man, who had alcoholic liver cirrhosis, suddenly developed blurred vision accompanied by a headache. After emergency ophthalmic surgery, topical brinzolamide was ap­plied to his eyes to control post-operative intra­ocular pressure resulting from pre-existing glau­coma. Two weeks later, after applying brinzolamide 3 times a day, the patient reported pruritic erythematous to violaceous targetoid papules with erosions on the oral and genital mucosa. The patient complained of intermittent high fever (> 38^oC). Erythematous patches developed on the face, palms and soles in the early stage, and then extended to other skin surface areas. Three days later, skin detachment developed over approximately 50% of his body surface area (Fig. 1A, B). Laboratory studies revealed an elevated LDH level (743 U/L; normal value 218~472 U/L) without any other significant changes. The blood cell count, rapid phase reactants, liver function tests, renal function tests and electrolytes were within normal limits in the early stage of the illness. He was initially treated with oral prednisolone at 45 mg per day, but epidermal detachment progressed to over 80% of his body. Intravenous immunoglobulin (IVIG) of 10 g was introduced, but a persistent high fever > 38.5^oC and neutropenia prohibited continuation of IVIG therapy. The skin lesions improved with re-epithe- lialization, although his general condition de­teriorated. The patient developed acute renal failure due to excessive water and albumin loss from the body surface. The patient died from sepsis on the 20th day after the initial skin lesion developed.

Read More…

INTRODUCTION

Carbonic anhydrase inhibitors (CAI) are com­monly used for lowering the intraocular pressure (IOP) in glaucoma and other ophthalmologic conditions. Carbonic anhydrase inhibitors are sulfo­namide derivatives that are known to cause a range of adverse reactions, including benign transient cutaneous rashes to life-threatening conditions, such as Toxic epidermal necrolysis (TEN). Systemic CAIs are among the most potent medications for lowering IOP, but their use is accompanied by troublesome side effects. In the dermatologic litera­ture, there are reports of Stevens-Johnson syndrome (SJS) and TEN associated with systemic CAIs in people of Japanese or Korean descent.

Read More…

Acrokeratosis paraneoplastica is an example of a paraneoplastic syndrome which reflects an underlying malignancy. The clinical manifestations include palmoplantar keratoderma, violaceous psoriasiform papulosquamous lesions, hyperpigmentation, and nail dystrophy. Acrokeratosis paraneoplastica has a characteristic symmetric bilateral acral distribution, primarily affecting white males of French extraction over 40 years of age. The most common associated neoplasms are squamous cell carcinoma of the upper respiratory tract and other tumors with cervical lymph node metastases. Also, various kinds of neoplasms in association with this syndrome are re¬ported, including prostate adenocarcinoma, bladder carcinoma, thymic carcinoma, squamous cell carci¬noma of the leg, breast carcinoma, hepatocellular carcinoma, vulvar carcinoma, lymphoma, and multiple myeloma3. Thus far, only one case asso¬ciated with colon cancer has been reported in the English literature. Involvement of the nails appears in more than three-quarters of the cases, with subungal hyperkeratosis, ridging, thickening, onycholy- sis, pigmentation, anonychia, and onychomadesis.

Read More…

A 63-year-old Korean woman visited our der- matologic clinic with an 11 month history of hyperkeratotic lesions on the palms and soles. The routine laboratory tests, including a complete blood count, liver function tests, and urine analysis revealed values all within the normal range or negative findings. The physical examination revealed yellowish punctuate hyperkeratotic lesions on the palms and soles (Fig. 1A, B), as well as onycholysis of the toenails and fingernails (Fig. 1C, D). She had no subjective symptoms, such as pruritus or pain.

Read More…

INTRODUCTION

Acrokeratosis paraneoplastica (Bazex syndrome) is a rare disorder characterized by the presence of hyperkeratotic lesions involving the nose, ears, palms, and soles that appears in association with various malignancies. It was first reported by Gougerot and Grupper in 1922. Cutaneous lesions manifest as violaceous to erythematous psoriasiform lesions favoring the acral areas and including the hands, feet, nose, ears, and nails, with subungal hyperkeratotic and onycholytic lesions. Most of the affected patients are white males, approximately 40 years of age. The most common associated neo­plasms are malignancies of the upper aerodigestive system, and other kinds of tumors with cervical lymph node metastasis, but there are some cases that develop from other tumors in the prostate, bladder, thymus, leg, and breast. A case of Bazex syndrome associated with adenocarcinoma of the colon was first reported in 2000. No other cases of Bazex syndrome associated with colon cancer have been published in the English literature to date.

Read More…