76th Meeting of the Ulster Society of Internal Medicine

Aquagenic wrinkling of the palms in adult patients with cystic fibrosis. Aquagenic Wrinkling of the Palms (AWP) is characterised by the development of oedematous white plaques on the hands following exposure to water. To date 30 cases of AWP have been reported, 17 of which are in patients with cystic fibrosis (CF) 1. Only two cases have been reported in males 1,2. We have identified 45 patients out of a cohort of 102 adult CF patients who describe AWP. 24 cases are male and 21 female. 25 patients give a very good history of wrinkling of the hands when immersed in water, 13 give an average history and formal testing has been carried out in 7 patients with positive results. In most patients the whole of the hand is affected and not just the finger tips. Eight patients state that the reaction is painful. Eight of the patients report desquamation, especially at the finger tips, shortly after the hands are out of water. A similar reaction involving the feet is also described by seven patients. Fourteen describe mild to moderate hyperhidrosis of the hands. We tested seven patients by placing one hand in warm tap water; the other hand was used as comparison. After 15 minutes of immersion AWP was demonstrated in all cases. The whole of the hand appeared white in colour, oedematous and excessively wrinkled. Conclusion: we present the clinical features of this interesting phenomenon and postulate that the incidence of AWP is likely to be much higher than the small numbers reported in the literature to date. wrinkling of the palms in patients with cystic fibrosis homozygous for the ΔF508 CFTR mutation. and the NCEPOD 3. Background: Percutaneous endoscopic gastrostomy (PEG) is an accepted method of placing a feeding tube to enable enteral feeding in patients with swallowing difficulties. However the factors associated with morbidity and mortality following PEG have not been studied in detail. We describe the largest audit of mortality following PEG tube insertion. Methods: Deaths occurring within 30 days following PEG tube insertion in the United Kingdom between April 2002 and March 2003 were identified and a questionnaire sent to the consultant endoscopist for completion. Results: 719 patients (391 male, median age 80 yrs.; range 26-98 yrs.) who died within 30 days following PEG insertion were identified. 97% of patients had co-existent neurological disease. PEG tubes were inserted by specialised GI physicians in 522 …