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Cutaneous metastases are an uncommon manifestation of visceral malignancy. We report a case of a 56-year-old male who presented with an ulcerated scrotal mass and inguinal swelling on the left side. Fine needle aspiration from both the sites revealed deposits of renal cell carcinoma though the patient had no urologic symptoms. Subsequent work-up revealed a renal mass. This case emphasizes the importance of keeping renal cell carcinoma as differential in cases who present with cutaneous metastases.

Background: Patients with active ulcerative colitis are treated with corticosteroids. We compared the efficacy and safety of intramuscular depot preparation of methylprednisolone acetate with oral prednisolone in the treatment of moderately active ulcerative colitis., Design: Open labeled, randomized, prospective, four-month study., Methods: 40 patients with moderately active ulcerative colitis (activity index 150-220) were randomized into two groups. Group A (n=21) received methylprednisolone acetate (80 mg intramuscularly once weekly for 6 weeks). Group B (n=19) received oral prednisolone (40 mg/day) in a 'tailing-off' regimen. In addition, patients in both the groups received sulfasalazine. Patients were followed up at 1, 2, 3, 4, 8, 12 and 16 weeks. The primary measure of therapeutic response was activity index. An index of <150 was considered as clinical remission. Secondary efficacy was assessed by subjective evaluation of acceptability of treatment by the patient., Results: After one week of treatment, the decrease in mean activity index was significantly more with oral prednisolone (p<0.05), and five 5 patients (23.8%) in Group A and 12 (63.2%) in Group B were in clinical remission (p<0.05). However, after 2 weeks and beyond, the mean activity index and the number of patients with clinical remission were comparable in the two treatment groups., Conclusions: Methylprednisolone acetate as a depot preparation and oral prednisolone are equally effective in inducing remission in patients with moderately active ulcerative colitis. Though symptomatic improvement is quicker with oral prednisolone, the remission rate with the two drugs was similar after 2 weeks of treatment.

Coexistence of celiac disease and ulcerative colitis has been reported from Western countries. We report two patients, a 30-year old man and a 16-year old boy, who presented initially with features of celiac disease and later developed ulcerative colitis.

Objective: To evaluate patient knowledge about ulcerative colitis and relate this to their socio-demographic characteristics., Methods: 145 patients with ulcerative colitis were given a two-sectioned awareness questionnaire in a language they understood. The first section, which tested disease awareness, consisted of 16 items. Awareness was classified as very low (< or = 4 correct answers), low (5-8), medium (9-12) and high (13-16). The second section contained 11 questions pertaining to general opinions and views about the disease., Results: Nine (6.2%) participants had very low level of awareness, 107 (73.8%) low level, 29 (20%) medium, and none high disease awareness. Only disease duration influenced disease awareness significantly. Age, sex, marital status, occupation and education level had no relation to the level of awareness. A majority of patients resorted to use of alternative medicines during their disease course; however, with increasing awareness the use of other types of therapy was reduced. Drug compliance had significant association with disease awareness., Conclusions: Our patients with ulcerative colitis had poor disease awareness. Since awareness affected treatment compliance, the study emphasizes the need for better education of the patients and their family about the disease.

Objective: To investigate the efficacy of azathioprine in treating patients with severe ulcerative colitis., Design: One-year, randomized, placebo-controlled trial., Subjects: 83 patients with severe ulcerative colitis were enrolled. Fifty patients who relapsed within two months on corticosteroid withdrawal were randomized into two groups. The azathioprine group received oral sulfasalazine (6-8 g/day), oral prednisolone (1 mg/Kg/day) and oral azathioprine (2 mg/Kg/day). The placebo group received oral sulfasalazine (6-8 g/day), oral prednisolone (1 mg/Kg/day) and placebo. Corticosteroids were tapered over 12-16 weeks., Results: Five patients (2 in azathioprine group, 3 in placebo group) dropped out of the study. Three patients in the azathioprine group had side effects. The number of patients going into complete remission and partial remission was not significantly different in the two groups. The proportion of relapses in the azathioprine group was lower than in the placebo group (p < 0.05)., Conclusions: In patients with ulcerative colitis, azathioprine had no effect in achieving remission, when given in combination with prednisolone; however, it lowers the proportion of relapses. Side effects like pancreatitis and hepatitis are mild and respond promptly to drug withdrawal.