Objective The literature suggests a lack of consensus on the use of terms related to coeliac disease (CD) and gluten. Design A multidisciplinary task force of 16 physicians from seven countries used the electronic database PubMed to review the literature for CD-related terms up to January 2011. Teams of physicians then suggested a definition for each term, followed by feedback of these definitions through a web survey on definitions, discussions during a meeting in Oslo and phone conferences. In addition to ‘CD’, the following descriptors of CD were evaluated (in alphabetical order): asymptomatic, atypical, classical, latent, non-classical, overt, paediatric classical, potential, refractory, silent, subclinical, symptomatic, typical, CD serology, CD autoimmunity, genetically at risk of CD, dermatitis herpetiformis, gluten, gluten ataxia, gluten intolerance, gluten sensitivity and gliadin-specific antibodies. Results CD was defined as ‘a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals’. Classical CD was defined as ‘CD presenting with signs and symptoms of malabsorption. Diarrhoea, steatorrhoea, weight loss or growth failure is required.’ ‘Gluten-related disorders’ is the suggested umbrella term for all diseases triggered by gluten and the term gluten intolerance should not to be used. Other definitions are presented in the paper. Conclusion This paper presents the Oslo definitions for CD-related terms.

https://gut.bmj.com/content/gutjnl/62/1/43.full.pdf

The Oslo definitions for coeliac disease and related terms

OBJECTIVE\nTo determine the excess length of stay, extra costs, and mortality attributable to nosocomial bloodstream infection in critically ill patients.\n\n\nDESIGN\nPairwise-matched (1:1) case-control study.\n\n\nSETTING\nSurgical intensive care unit (SICU) in a tertiary health care institution.\n\n\nPATIENTS\nAll patients admitted in the SICU between July 1, 1988, and June 30, 1990, were eligible. Cases were defined as patients with nosocomial bloodstream infection; controls were selected according to matching variables in a stepwise fashion.\n\n\nMETHODS\nMatching variables were primary diagnosis for admission, age, sex, length of stay before the day of infection in cases, and total number of discharge diagnoses. Matching was successful for 89% of the cohort; 86 matched case-control pairs were studied.\n\n\nMAIN OUTCOME MEASURES\nCrude and attributable mortality, excess length of hospital and SICU stay, and overall costs.\n\n\nRESULTS\nNosocomial bloodstream infection complicated 2.67 per 100 admissions to the SICU during the study period. The crude mortality rates from cases and controls were 50% and 15%, respectively (P < .01); thus, the estimated attributable mortality rate was 35% (95% confidence interval, 25% to 45%). The median length of hospital stay significantly differed between cases and controls (40 vs 26 days, respectively; P < .01). When only matched pairs who survived bloodstream infection were considered (n = 41), cases stayed in the hospital a median of 54 days vs 30 days for controls (P < .01), and cases stayed in the SICU a median of 15 days vs 7 days for controls (P < .01). Thus, extra hospital and SICU length of stay attributable to bloodstream infection was 24 and 8 days, respectively. Extra costs attributable to the infection averaged $40,000 per survivor.\n\n\nCONCLUSIONS\nThe attributable mortality from nosocomial bloodstream infection is high in critically ill patients. The infection is associated with a doubling of the SICU stay, an excess length of hospital stay of 24 days in survivors, and a significant economic burden.

Nosocomial Bloodstream Infection in Critically Ill Adults: Excess Length of Stay, Extra Costs, and Attributable Mortality

A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals. In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide. Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010. This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns. This review will summarize our current knowledge about the three main forms of gluten reactions: allergic (wheat allergy), autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia) and possibly immune-mediated (gluten sensitivity), and also outline pathogenic, clinical and epidemiological differences and propose new nomenclature and classifications.

/pdf/spectrum-of-gluten-related-disorders-consensus-on-new-2zxekn7y4r.pdf

Spectrum of gluten-related disorders: consensus on new nomenclature and classification

Remains your authoritative source for comprehensive coverage of those skin diseases in which histopathology plays an important role in diagnosis. This edition maintains the proven, clinicopathologic classification of cutaneous disease while incorporating a “primer” on pattern-algorithm diagnosis. More than 1,800 full-color illustrations, including photomicrographs and clinical photographs, help you visualize and make the most of the clinical diagnostic process.

Lever's Histopathology of the Skin

This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This second part of the guideline covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions, whereas the first part covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy. Management of AE must consider the individual clinical variability of the disease. Systemic immunosuppressive treatment with cyclosporine, methotrexate, azathioprine and mycophenolic acid is established option for severe refractory cases, and widely available. Biologicals targeting the T helper 2 pathway such as dupilumab may be a safe and effective, disease-modifying alternative when available. Oral drugs such as JAK inhibitors and histamine 4 receptor antagonists are in development. Microbial colonization and superinfection may cause disease exacerbation and can require additional antimicrobial treatment. Allergen-specific immunotherapy with aeroallergens may be considered in selected cases. Psychosomatic counselling is recommended especially in stress-induced exacerbations. Therapeutic patient education ('Eczema school') is recommended for children and adult patients. General measures, basic emollient treatment, bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy have been addressed in the first part of the guideline.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.14891

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I.

1962; 16: 187–94. 3 Bourlond J. Erosive adenomatosis of the nipple. Dermatology 1992; 185: 319–24. 4 Menet E, Vabres P, Brecheteau P et al. Pigmented Paget’s disease of the male nipple. Ann Dermatol Venereol 2001; 128: 649–52. 5 Kuflik EG. Erosive adenomatosis of the nipple treated with cryosurgery. J Am Acad Dermatol 1998; 38: 270–1. 6 Hye JL, Kee YC. Erosive adenomatosis of the nipple: Conservaation of nipple by Mohs micrographic surgery. J Am Acad Dermatol 2002; 47: 578–80.

Chronic autoimmune urticaria in a patient with multiple piloleiomyomas.

[Premises and preliminary programming for the use of the computer in dermato-allergological diagnosis].

Indagine epidemiologica sulle dermatofitosi nella provincia di Sassari dal 1983 al 1987.

Is dermatitis herpetiformis changing

A 54-year-old man attended our clinic for extensive ulcerations of the scalp and face. Over the previous 4 years, similar ulcers had developed on the retroauricular and nucal regions. On examination an irregular, deep and purulent ulcer with raised inflammatory edges was observed on the vertex area (Fig. 1). A small ulcer with a necrotic base was also present on the left temple, and pustules, abrasions and small ulcerations extended from [...]

Malignant pyoderma responding to cyclosporine

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