Asunto(s)
Anilidas/efectos adversos , Antineoplásicos/efectos adversos , Carcinoma Basocelular/tratamiento farmacológico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Piridinas/efectos adversos , Calidad de Vida , Neoplasias Cutáneas/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Anilidas/administración & dosificación , Antineoplásicos/administración & dosificación , Carcinoma Basocelular/complicaciones , Carcinoma Basocelular/diagnóstico , Esquema de Medicación , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Femenino , Proteínas Hedgehog/antagonistas & inhibidores , Proteínas Hedgehog/metabolismo , Humanos , Masculino , Piridinas/administración & dosificación , Índice de Severidad de la Enfermedad , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/diagnósticoRESUMEN
BACKGROUND: Epidemiological and clinical data suggest that actinic damage to the skin is an important predictor of skin carcinogenesis. AIM: To investigate the association of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) with sun-damage alterations seen by histopathology. METHOD: In the current prospective study, perilesional skin of SCC or BCC lesions was evaluated for presence of alterations associated with chronic photodamage. Presence of scarring, perineural/perivascular invasion, haemorrhage/haemorrhagic crust, ulceration/erosion and margin involvement were also assessed. RESULT: Of 6038 included lesions, 4523 (74.9%) were BCCs and 1515 (25.1%) were SCCs. Presence of actinic damage was five times more frequent in SCC than in BCC (OR = 5.29, 95% CI 4.44-6.00, P < 0.001), and diagnosis of SCC was twice as common in photo-exposed than nonphoto-exposed body sites (OR = 2.34, 95% CI 2.03-2.70, P < 0.001). There were twofold higher odds for actinic damage in SCC compared with Bowen disease (OR = 2.015, 95% CI 1.55-2.61, P < 0.001). Assessing the different BCC histological subtypes, we found that nodular BCC had at least twofold higher odds (OR = 2.63, 95% CI 2.09-3.32), infiltrative BCC had 48% higher odds (OR = 1.487, 95% CI 1.18-1.87) and basosquamous BCC had fourfold higher odds (OR = 4.10, 95% CI 3.01-5.57) of having actinic damage compared with superficial BCC. CONCLUSIONS: Histological verification of ultraviolet-associated alterations in the perilesional skin in patients with NMSC in our study confirms the aetiopathogenic link between sun exposure and epithelial carcinogenesis on a histopathological basis. This correlation was stronger for SCCs than for BCCs.
Asunto(s)
Carcinoma Basocelular/patología , Carcinoma de Células Escamosas/patología , Neoplasias Cutáneas/patología , Piel/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad de Bowen/patología , Carcinogénesis/efectos de la radiación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Rayos Ultravioleta/efectos adversos , Adulto JovenRESUMEN
Non melanoma skin cancers (NMSC) are the most common human neoplasms, encompassing basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), but also cutaneous lymphomas, adnexal tumors, merckel cell carcinoma and other rare tumors. The incidence of BCC and SCC varies significantly among different populations, and the overall incidence of both tumors has increased over the last decades. Although generally associated with a favorable prognosis, recent evidence suggests that the mortality rates of SCC might have been underestimated up-to-date.1 According to Medicare data, NMSC is the fifth most expensive cancer for health care systems. This increased economic burden is not associated with the cost of treating an individual patient, but with the large number of affected patients and the recurrence rates.2 Therefore, the adequate management of the primary tumor with a complete excision becomes a priority not only for the patient but also for the public health systems. Multiple treatment modalities are currently usedin clinicalpractice for the treatment of NMSC. While surgical excision (SE) remains the gold standard of care, non-surgical techniques have gained appreciation due to lower morbidity and better cosmetic results. The optimal management of treatment includes a complete tumor clearance, preservation of the normal tissue function, and the best possible cosmetic outcome.3 Surgery with a predefined excision margin is the treatment of choice for most NMSCs, with Mohs micrographic surgery being recommended for tumors considered to be at a higher recurrence risk or those developing on cosmetically sensitive areas.4, 5 Therefore, the surgical approach of a NMSC consists with three different and equally important steps. First the preoperative clinical assessment of the tumor margins, which can be facilitated by the use of dermoscopy. Second, the definition of the surgical margins depending on the tumor subtype and its biological behavior. Finally, the surgical procedure must be designed based on the anatomic site and the patient's charachteristics. This preoperative assessment requires specific skills and might be performed by a physician, the dermatosurgeon, two collaborating specialists, namely a dermatologist and a surgeon.
Asunto(s)
Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Cutáneas/cirugía , Carcinoma Basocelular/epidemiología , Carcinoma Basocelular/patología , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Competencia Clínica , Conducta Cooperativa , Dermoscopía/métodos , Humanos , Incidencia , Cirugía de Mohs/métodos , Cuidados Preoperatorios/métodos , Pronóstico , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/patología , EspecializaciónAsunto(s)
Carcinoma de Células Escamosas/inducido químicamente , Erupciones por Medicamentos/etiología , Queratoacantoma/inducido químicamente , Inhibidores de Proteínas Quinasas/efectos adversos , Pirazoles/efectos adversos , Neoplasias Cutáneas/inducido químicamente , Anciano , Femenino , Neoplasias de Cabeza y Cuello/inducido químicamente , Humanos , Nitrilos , Mielofibrosis Primaria/tratamiento farmacológico , PirimidinasAsunto(s)
Acné Vulgar/epidemiología , Inmunodeficiencia Variable Común/epidemiología , Dermatitis Atópica/epidemiología , Deficiencia de IgA/epidemiología , Psoriasis/epidemiología , Enfermedades Cutáneas Infecciosas/epidemiología , Acné Vulgar/inmunología , Adolescente , Alopecia/epidemiología , Alopecia/inmunología , Niño , Estudios de Cohortes , Inmunodeficiencia Variable Común/inmunología , Dermatitis Atópica/inmunología , Femenino , Humanos , Deficiencia de IgA/inmunología , Estudios Longitudinales , Masculino , Estudios Prospectivos , Psoriasis/inmunología , Enfermedades Cutáneas Infecciosas/inmunología , Vitíligo/epidemiología , Vitíligo/inmunología , Adulto JovenRESUMEN
BACKGROUND: Basal cell carcinoma (BCC) is the most common cancer, it represents a significant economic burden to health services because of a large volume of affected patients. Surgical excision with histological assessment of the surgical margins is widely considered as the mainstay of BCC treatment. Incomplete removal, in fact, should be considered a poor prognostic indicator, as incomplete removal of lesions is at risk of local recurrence. Actually, dermatological surgeries are carried out by a variety of different types of practitioners, such as plastic surgeons, maxillofacial surgeons, otorhinolaryngologists, ophthalmologists and finally dermatologists. Incomplete removal of the tumour ranges from 6.3% to 25%, depending on the improper intra-operative evaluation of the extent of the tumour. It depends on the clinical knowledge derived from both training and daily experience. In this sense, the majority of the largest studies derive from plastic surgeons, while dermatologists have small case series, albeit with a higher therapeutic efficacy in terms of complete surgical excision. OBJECTIVES: We conducted a retrospective analysis of the surgical activity, more specifically we evaluated both our therapeutic accuracy and analyzed the prognostic factors related to incomplete excisions. METHODS: A retrospective review of all BCC removals was performed. A total of 4523 BCC removals were included; other neoplasm, benign lesions and biopsies were also excluded. Each BCC's size diameter, localization, histology and histological presence of complicating factors was assessed, then the percentage of the incomplete removal was calculated. RESULTS: Incomplete resections occurred in 225 (4.97%) BCCs of the cases. Thirteen areas were categorized into in three different levels that rank the risk of incomplete removals. Sub-analysis indicates that just over a third had no complicating factors with the lateral/deep margins. The most frequent complicating factor is ulceration (22.9%), while vascular invasion or seborrheic keratoses were not found. Actinic keratoses, scabs and scars held the most responsibility for the involvement of the lateral margins, while perineural invasion is the main factor leading to deep margin involvement. Finally, a different trend for the involvement of lateral or deep margins according different histological sub-types was highlighted; lateral involvement is more frequent for the infiltrative/morpheic type, while the deep margin is more involved in the nodular type.
Asunto(s)
Carcinoma Basocelular/complicaciones , Recurrencia Local de Neoplasia/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/economía , Carcinoma Basocelular/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/economía , Recurrencia Local de Neoplasia/patología , Adulto JovenRESUMEN
No disponible
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Deficiencia de IgA/diagnóstico , Deficiencia de IgA/inmunología , Deficiencia de IgA/terapia , Inmunodeficiencia Variable Común/complicaciones , Inmunodeficiencia Variable Común/diagnóstico , Inmunodeficiencia Variable Común/inmunología , Dermatitis Atópica/complicaciones , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/terapia , Inmunodeficiencia Variable Común/fisiopatología , Inmunodeficiencia Variable Común/terapia , Dermatitis Atópica/fisiopatología , Psoriasis/complicaciones , Psoriasis/diagnóstico , Psoriasis/inmunología , Vitíligo/complicacionesRESUMEN
BACKGROUND: Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) is a hereditary autoinflammatory syndrome characterized by recurrent episodes of fever and localized inflammation. Clinical presentation can be very variable in terms of duration of fever attacks, periodicity, and accompanying manifestations. One of the most characteristic symptoms is the occurrence of migrating skin rash with myalgia that is sustained by monocytic inflammation. OBSERVATIONS: We herein present the case of a family suffering from TRAPS who had been misdiagnosed for a long period of time and whose main symptom was migrating angioedema. Skin biopsy from one of the patients documented a monocytic panniculitis. All the living patients responded dramatically to anakinra treatment. CONCLUSIONS: The classic symptom of migratory angioedema with myalgia in TRAPS can be produced by monocytic panniculitis.This manifestation is so characteristic of TRAPS that its occurrence, even in the absence of other manifestations, should prompt genetic analysis. Our patient's condition responded promptly to anakinra treatment.
Asunto(s)
Angioedema/etiología , Antirreumáticos/uso terapéutico , Enfermedades Autoinflamatorias Hereditarias/tratamiento farmacológico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Femenino , Fiebre , Enfermedades Autoinflamatorias Hereditarias/diagnóstico , Enfermedades Autoinflamatorias Hereditarias/genética , Humanos , Masculino , Mutación , Receptores Tipo I de Factores de Necrosis Tumoral/genética , Recurrencia , Adulto JovenAsunto(s)
Ciclosporina/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Necrobiosis Lipoidea/tratamiento farmacológico , Necrobiosis Lipoidea/patología , Abdomen/patología , Administración Oral , Adolescente , Mama/patología , Ciclosporina/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Diabetes Mellitus Tipo 1/complicaciones , Femenino , Humanos , Pierna/patología , Necrobiosis Lipoidea/diagnóstico , Necrobiosis Lipoidea/etiología , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Frío/efectos adversos , Fármacos Dermatológicos/uso terapéutico , Inmunoglobulina G/uso terapéutico , Psoriasis/tratamiento farmacológico , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Urticaria/tratamiento farmacológico , Etanercept , Humanos , Masculino , Adulto JovenAsunto(s)
Anticuerpos Antinucleares/genética , Lupus Eritematoso Cutáneo/inmunología , Anticuerpos Antinucleares/inmunología , Enfermedades en Gemelos/enzimología , Enfermedades en Gemelos/inmunología , Femenino , Humanos , Lactante , Recién Nacido , Lupus Eritematoso Cutáneo/enzimología , Lupus Eritematoso Cutáneo/patología , Masculino , Embarazo , Hermanos , Resultado del TratamientoRESUMEN
An association between Borrelia burgdorferi with primary cutaneous B-cell lymphoma (PCBCL) has long been suspected but just recently, thanks to a polymerase chain reaction technique, it had been possible to demonstrate B. burgdorferi-specific DNA in skin lesions of patients with different PCBCL subtypes. Locating cases of PCBCL that are related to B. burgdorferi infection could be really important for therapeutic implications; in fact, there are several reports of PCBCL responding to antibiotic therapy against B. burgdorferi. We report a case of B. burgdorferi-associated primary cutaneous marginal-zone B-cell lymphoma that, after specific antimicrobial therapy, did not show any clinical regression. We can conclude that additional studies are necessary in order to establish the use of antimicrobial therapy in B. burgdorferi-associated PCBCL.
Asunto(s)
Antibacterianos/administración & dosificación , Borrelia burgdorferi/aislamiento & purificación , Doxiciclina/administración & dosificación , Enfermedad de Lyme/complicaciones , Linfoma de Células B/microbiología , Neoplasias Cutáneas/microbiología , Administración Oral , Anciano , ADN Bacteriano , Humanos , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/cirugía , Masculino , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/cirugía , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
A store-and-forward teleconsultation system was established for 36 Italian hospitals located in 22 different countries. Referrals were made to a network of 33 health centres in Italy via a management centre (MC). The MC was equipped with a server to manage the service. The participating hospitals used client workstations with special software. The referring centres generated teleconsultation requests, which were sent to the MC and allocated manually by the latter to the most appropriate specialist on the basis of information provided in the message. From 1 June 2005 to 15 March 2006, 187 enquiries out of 221 were answered. The median response time was two days. A service satisfaction survey was conducted among the users and about 90% of the responses were positive. The teleconsultation system represents a mechanism for providing equitable access to health care for all the referring doctors.
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Hospitales , Consulta Remota/organización & administración , Adolescente , Adulto , Anciano , Niño , Preescolar , Atención a la Salud , Hospitales/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Italia , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Consulta Remota/estadística & datos numéricosRESUMEN
In this study we report the case of an acute form of ATL in a HTLV-I-infected Nigeria-born 27-year-old female prostitute living in Italy from February, 2001. The presence of HTLV-I infection was demonstrated by the detection of serum antibody to HTLV-I by immunoenzymatic assay and western blot analysis. In addition, the presence of HTLV-I proviral DNA was confirmed by a hemi-nested PCR in a sample of peripheral blood mononuclear cells. From an epidemiological point of view, it is important to report new cases of imported ATL, as it may explain the otherwise untraceable origin of some rare and apparently autochthonous cases of ATL in non-endemic areas.
Asunto(s)
Virus Linfotrópico T Tipo 1 Humano/aislamiento & purificación , Leucemia-Linfoma de Células T del Adulto/diagnóstico , Leucemia-Linfoma de Células T del Adulto/inmunología , Enfermedad Aguda , Adulto , Anticuerpos Antivirales/sangre , ADN Viral/análisis , Femenino , Virus Linfotrópico T Tipo 1 Humano/genética , Virus Linfotrópico T Tipo 1 Humano/inmunología , Humanos , Italia , Nigeria/etnología , Reacción en Cadena de la PolimerasaRESUMEN
The routine determination of drug resistance in newly HIV-1 infected individuals records a potential increase in transmissions of drug-resistant variants. Plasma samples from 38 individuals classified as newly infected (seroconversion time <12 months) and twenty four individuals with an established infection (seroconversion time ranging from 3 to 10 years) were analyzed for the presence of mutations by Trugene HIV-1 genotyping assay and Virtual phenotype. Results on the newly infected and the chronically infected individuals showed a limited number of relevant mutations associated with substantial resistance to reverse transcriptase and protease inhibitors. In particular, three patients (4.8%) carried viral major mutations (T69D and M41L) associated with resistance to reverse transcriptase inhibitors, whereas only one showed the presence of M46L, which is correlated with partial resistance to some protease inhibitors. The clinical interpretation based on different approaches to monitor resistance showed that the Virconet interpretation was less grave than Trugene, suggesting that these interpretations need standardization for the currently used sequencing methods and that they may be associated with different outcomes when eventually are used.
Asunto(s)
Sustitución de Aminoácidos , Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral/genética , Proteasa del VIH/genética , Transcriptasa Inversa del VIH/genética , VIH-1/efectos de los fármacos , Enfermedad Aguda , Adulto , Fármacos Anti-VIH/uso terapéutico , Enfermedad Crónica , Estudios de Cohortes , Femenino , Infecciones por VIH/tratamiento farmacológico , VIH-1/enzimología , VIH-1/genética , Humanos , Masculino , Prevalencia , Juego de Reactivos para Diagnóstico/normas , Análisis de Secuencia de ADN/normasRESUMEN
Since the discovery of 3'-azido-3'deoxthymidine (zidovudine) as an effective antiretroviral agent against human immunodeficiency virus type 1 (HIV-1), drug therapy has been widely used in the treatment of AIDS. To date, new combination therapies have significantly altered the longterm prognosis for HIV-infected patients showing a reduction of plasma viral load, associated with clinical and immunological recovery. Nevertheless, in various circumstances treatment can fail for several reasons, such as patient noncompliance with the therapeutic regimen, suboptimal antiviral drug concentrations, drug pharmacokinetics, and virus resistance to one or more drugs. Virus drug resistance is the most important factor contributing to the failure of antiretroviral therapy. Since some evidence indicates that viral resistance and treatment failure are closely linked, this brief review explores the routine determination of drug resistance and its importance to shed more light on the meaning of mutations correlated to drug resistance.