The management of endoscopic retrograde cholangio- pancreatography-related infections risk: results of an italian survey at regional level.

Background and aim: Among the Endoscopic retrograde cholangiopancreatography (ERCP) adverse events, an increasingly arising problem is the transmission of Multi Drug Resistant (MDR) Bacteria through duodenoscopes. The aim of this survey was to evaluate the current clinical practice of management of ERCP associated infections in Emilia-Romagna, Italy. Methods: An online survey was developed including 12 questions on management of ERCP associated infections risk. The survey was proposed to all 12 endoscopy centers in Emilia Romagna that perform at least > 200 ERCPs per year. Results: 11 centers completed the survey (92%). Among all risk factors of ERCP infections, hospitalization in intensive care units, immunosuppressant therapies, and previous MDR infections have achieved a 80 % minimum of concurrence by our respondents. The majority of them did not have a formalized document in their hospital describing categories and risk factors helpful in the detection of patients undergoing ERCP with an high-level infective risk (9/11, 82%). Most centers (8/11, 72%) do not perform screening in patients at risk of ERCP infections. Post procedural monitoring is performed by 6 of 11 centers (55%). Conclusion: Our survey showed that, at least at regional level, there is a lack of procedures and protocols related to the management of patients at risk of ERCP infections.

Real-life efficacy and safety of Ustekinumab as second- or third-line therapy in Crohn's disease: results from a large Italian cohort study.

OBJECTIVE: Ustekinumab (UST) is an anti-IL12/23 antibody for the treatment of Crohn's Disease (CD). The aim of this study was to compare the efficacy and safety of UST in a large population-based cohort of CD patients who failed previous treatment with other biologics. PATIENTS AND METHODS: 194 CD patients (108 males and 86 females, mean age 48 years (range 38-58 years) were retrospectively reviewed. 147 patients were already treated with anti-TNFα (75.8%), and 47 (24.2%) patients were already treated with anti-TNFα and vedolizumab. Concomitant treatment with steroids was present in 177 (91.2%) patients. RESULTS: At week 12, clinical remission was achieved in 146 (75.2%) patients. After a mean follow-up of 6 months, clinical remission was maintained in 135 (69.6%) patients; at that time, mucosal healing was assessed in 62 (31.9%) patients, and it was achieved in 33 (53.2) patients. Three (1.5%) patients were submitted to surgery. Steroid-free remission was achieved in 115 (59.3%) patients. Both serum C-Reactive Protein and Fecal Calprotectin (FC) levels were significantly reduced with respect to baseline levels during follow-up. A logistic regression, UST therapy as third-line therapy (after both anti-TNFα and vedolizumab), FC >200 µg/g, and HBI ≥8 were significantly associated with lack of remission. Adverse events occurred in 5 (2.6%) patients, and four of them required suspension of treatment. CONCLUSIONS: UST seemed to be really effective and safe in CD patients unresponsive to other biologic treatments, especially when used as second-line treatment.

Dermatologic radiotherapy in the treatment of extensive basal cell carcinomas: a retrospective study.

BACKGROUND: The increase of the number of new cases for year of basal cell carcinoma (BCC) has brought also an increase of BCC difficult to treat (extensive, locally advanced and high risk forms). OBJECTIVE: To evaluate retrospectively the results obtained with dermatologic radiotherapy (RT) for better defining the indications respect to new emerging treatments. METHODS: A series of extensive 115 BCC treated with RT from 1977 to 2014 were selected for the study, since endowed with histological diagnosis on the amount of 181 extensive BCC. RT was performed with conventional energies (50-160 kV) administering a total dose ranging from 47 to 85 Gy (median 55 Gy). The mean follow up was 40.66 months (median 21 months). A statistical evaluation was performed with chi-square test to analyse the possible correlations among therapeutic and cosmetic results and size, localisation and clinical type of the lesions. RESULTS: A complete remission (CR) was obtained in 70.43%, a partial remission (PR) in 20% of the lesions treated, while in 9.56% a no response (NR) or not evaluable response (NER) was registered. In 19% of the lesions a relapse was observed, with a five-year cure-rate of 55.13%. Cosmetic results were good in 28%, acceptable in 50% and not acceptable in 22% of the lesions in CR. In six lesions, localised at the trunk region, a chronic radiodermatitis developed. A statistically significative correlation was observed between therapeutic results and size, between cosmetic results and size and between therapeutic results and clinical type of BCC. CONCLUSION: The treatment of extensive BCC is still a challenge and radiotherapy is one of the possible choices, preferred in the elderly, in relapsing cases, after incomplete excision, and in difficult localisations of the face. Radiotherapy might be included in sequential schedules of treatment to improve final results.

Relevance of dermatologic radiotherapy in the therapeutic strategy of skin epithelial neoplasms: excellent results in the treatment of lesions localized on eyelids and skin overlying the cartilage of the nose.

AIM: Epithelial cancer of the skin is the most common human neoplasm. In spite of the multiple modalities of treatment available, about 10 % of these tumours results resistant to them. Therefore, improving the therapeutic strategies is mandatory. METHODS: A retrospective study has been carried out on 905 patients affected by 986 basal and squamous cell carcinoma, histologically ascertained, localized on eyelids and on skin overlying the cartilages of the nose treated with conventional radiotherapy. All the lesions were classified according to TNM classification. RESULTS: Follow-up ranged from 1 to 425 months. The five-year cure-rate was 96.38% for eyelids neoplasms and 92.43% for those localized on skin covering nose cartilages, respectively. The percentage of relapse was 5.47%.The graphic representation shows how the risk of relapse remains high for the first five years. On the whole cosmetic and functional outcomes were good. CONCLUSION: Our results confirm dermatologic radiotherapy as a treatment proper to afford very high cure-rates, and support the importance of a correct follow-up. The knowledge of these data and the possibility to compare them with others obtained by different therapies and endowed with histopathologic investigation, TNM classification, adequate follow-up and significant clinical series would result in improvement of the management of skin epithelial neoplasms.

Intralesional vincristine as first-line therapy for nodular lesions in classic Kaposi sarcoma: a prospective study in 151 patients.

BACKGROUND: Classic Kaposi sarcoma is a rare angioproliferative neoplasm with varying biological behaviour. Depending on the clinical stage, local or systemic therapy can be used. Vincristine has proven to be effective as systemic chemotherapy and in very few reports as intralesional treatment. OBJECTIVES: Our aim was to determine the efficacy and safety of intralesional vincristine in the treatment of classic Kaposi sarcoma nodular lesions. METHODS: We conducted a prospective, open-label, single-centre clinical trial in 151 patients with stage IB classic Kaposi sarcoma. Vincristine was injected in a single nodule (0.3-0.8 mm) on the lower limb. Another similar lesion on the same limb, at a distance of >or= 10 cm, or on the contralateral limb, was kept under clinical observation as control. Adverse effects were evaluated after 1 week, and efficacy after 4 and 12 weeks. RESULTS: One hundred and fifty-one patients were enrolled. At final evaluation, 115 patients presented complete response (76.1%), 28 had partial response (18.5%), six had improvement (4%), one had stable disease (0.7%) and only one patient had tumour progression (0.7%). Therefore the total response rate was 98.7% (149 patients). Therapy was generally well tolerated. The most frequently registered adverse events, observed in 21 patients (13.9%), were erythema and itching. CONCLUSIONS: Intralesional vincristine is an effective and safe treatment for nodular lesions in classic Kaposi sarcoma and can be recommended as first-line therapy in initial stages and as support therapy in advanced stages.

Lymphogranuloma venereum: the Italian experience.

An epidemic of lymphogranuloma venereum (LGV) has been described in men who have sex with men (MSM) in the western world, particularly in western Europe. The first Italian case was reported by the authors in 2006, and up to March 2008 there have been 13 symptomatic cases, all in MSM. Ten cases had LGV proctitis and three cases had inguinal adenopathy as their clinical presentation. The initial three cases reported receptive anal intercourse in metropolitan areas of northern Europe, Turkey and eastern Europe, whereas the later cases were infections acquired locally. Diagnosis was by LGV-specific real-time PCR in nine cases, by symptoms and PCR for Chlamydia trachomatis in three cases, and in one case clinically and epidemiologically.