Calciphylaxis in dialysis patients, a severe disease poorly responding to therapies: report of 4 cases.

Calciphylaxis or calciphic uremic arteriolopathy (CUA) is a rare syndrome characterized by the deposition of calcium within the walls of small and medium size vessels in the dermis and in the subcutaneous tissue. The disease mainly affects patients with end-stage renal disease. We report here our experience with 4 cases of calciphylaxis in dialysis patients. The main predisposing factor observed in our 4 patients was warfarin use (2 patients, 50%), while local traumas and diabetes were respectively present in only one patient. None of our patients was obese. Lower legs were the most frequently involved site of CUA (3/4 patients, 75%). In our experience biopsy was crucial to achieve a correct diagnosis and did not cause aggravation of the ulcers. Therapeutic approach was multimodal: mainly hyperbaric oxygen therapy, cinacalcet and sodium thiosulphate. Although many recent case reports have shown exceptional results and healing with the use of sodium thiosulphate, we did not experience any change in the poor prognosis of our patients with the use of this drug, at a dosage of 5 g thrice weekly endovenously.

Prurigo nodularis (Hyde's prurigo) disclosing celiac disease.

A case of prurigo nodularis (Hyde's prurigo) preceding by 15 years the diagnosis of celiac disease is presented. In particular, the association between the clinical course of prurigo nodularis and the compliance with gluten-free diet is reported and discussed.

[Palliative surgery in nonresectable pancreatic carcinoma]. / Chirurgia palliativa nel carcinoma pancreatico non resecabile.

The authors report 30 cases of adenocarcinoma of the pancreas treated with palliative surgery at the 2nd Department of Surgery of S. Maria delle Croci Hospital in Ravenna, in the period 1985-1991. Biliary bypass or gastroenterostomy were performed because of severe jaundice and duodenal obstruction, and not with prophylactic intent. According to Fortner's classification 60% of the neoplasias were stage 3, 36.7% stage 2, and 3, 3% stage 1 tumors. The hospitalization mean time was 15 days, perioperative mortality was 6.6% and mean survival rate was 6.5 months. The authors conclude that palliative surgical treatment is useful in case of neoplastic biliary and duodenal stenoses, with no liver or lung metastases, and also whenever an histological evaluation of the tumor is necessary to evaluate resection chances.

[Incidence of neoplasm recurrence after colorectal resection for cancer]. / Incidenza delle recidive neoplastiche dopo resezione rettocolica per cancro.

The Authors report their experience on the incidence of anastomotic recurrence in 122 patients surgically treated with colorectal resection for cancer. The number of local recurrences (3 cases, that is 2.5%) is in the inferior range of what reported in Literature. Parameters that influence the local failure are: depth of tumor invasion, extension to adjacent organs and structures, presence of lymph node metastases (valuable with Dukes' modified staging). Type of operation and histologic grade do not seem to influence local recurrence. The Authors report the therapeutic choices adopted in the cases considered.

Longitudinal melanonychia induced by 3'-azidodeoxythymidine. Report of 9 cases.

9 Caucasian patients who developed longitudinal melanonychia during 3'-azidodeoxythymidine (AZT) treatment for HIV infection are reported. The occurrence of nail pigmentation was not related to drug dosage or to the severity of the HIV infection. AZT as well as other drugs acting on DNA synthesis or transcription seem to be a quite frequent cause of longitudinal melanonychia.