RESUMEN
Psoriasis, a chronic inflammatory condition, often presents challenges in treatment, particularly in areas such as nails, palms/soles, scalp/face, and genitalia. Monoclonal antibodies (mAb) like risankizumab targeting interleukin-23 (IL-23) have emerged as promising treatments, yet data on long-term efficacy remain limited. This multicenter retrospective study aimed to evaluate the drug survival at 12 and 36 months of 191 psoriasis patients treated with risankizumab, focusing on critical areas. Patients, previously unresponsive to first-line therapies, were treated according to Italian Guidelines. Survival analysis revealed a 97.6% one-year and 95% three-year drug survival rate. Secondary ineffectiveness was the primary reason for discontinuation, particularly in palmoplantar involvement cases. Factors such as BMI, gender, age, disease duration, baseline severity, and previous biologic exposure did not significantly impact drug survival, except for palmoplantar psoriasis (HR 4.72). Risankizumab demonstrated prolonged response with low treatment switch requirements, especially notable in challenging areas. Understanding such factors can aid in optimizing therapeutic approaches for improved patient care and long-term outcomes in managing psoriasis. Further research is warranted to refine treatment strategies in difficult-to-treat areas.
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Anticuerpos Monoclonales , Psoriasis , Humanos , Psoriasis/tratamiento farmacológico , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Anticuerpos Monoclonales/uso terapéutico , Anciano , Índice de Severidad de la Enfermedad , ItaliaRESUMEN
BACKGROUND: Taurolidine lock, a technique used to prevent or treat catheter-related bloodstream infection (CRBSI), is effective in adult and paediatric patients but has been described rarely in neonates. The aim of this descriptive retrospective study, was to determine the feasibility and direct outcomes of prophylactic and therapeutic taurolidine locks in term and preterm neonates. METHODS: We implemented the use of therapeutic taurolidine lock in addition to antibiotic treatment with the aim of catheter salvage in critical neonates with difficult vascular access (group 1). In addition, we introduced taurolidine lock as a preventive measure in neonates with a central venous catheter (CVC) at high risk of developing CRBSI (group 2). Every 24 h (in the treatment group) a 2% taurolidine solution was injected and the catheter locked for at least 120 min, until infection clearance (group 1). In the preventive group, the catheter was locked for 30 min every 48 h until CVC removal (group 2). FINDINGS: Thirty-seven neonates who received taurolidine were included in this study. We did not observe any major adverse events. In group 1 (21 cases), clinical symptom disappearance and bacteraemia clearance were achieved without catheter removal in 18 cases (85.7%); in the other three neonates the catheter was removed shortly after the start of the locks as it was possible to replace the CVC. In group 2 (16 neonates), no CRBSI was observed during the duration of the catheter placement. CONCLUSIONS: In this retrospective study, taurolidine was successfully used in neonates both for prevention and treatment of CRBSI, without major undesired effects. A larger cohort and a randomized clinical trial is warranted in order to establish its efficacy and safety in neonates.
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Bacteriemia , Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Catéteres Venosos Centrales , Taurina/análogos & derivados , Tiadiazinas , Adulto , Recién Nacido , Humanos , Niño , Estudios de Factibilidad , Estudios Retrospectivos , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/diagnóstico , Catéteres Venosos Centrales/efectos adversos , Cateterismo Venoso Central/efectos adversos , Bacteriemia/tratamiento farmacológico , Bacteriemia/prevención & controlRESUMEN
BACKGROUND AND PURPOSE: MR imaging provides means for discriminating different patterns of Hypoxic-ischemic encephalopathy (HIE) and may distinguish most severe cases from less severe but is unable to predict long-term outcome. Diffusion tensor imaging (DTI) offers information for a more complete characterization of HIE. The purpose of this study is to compare the modifications of DTI parameters in newborns one week and six months following total-body cooling to healthy controls. METHODS: Forty-seven cooled newborns were studied with MRI, 20 underwent follow-up at 6 months. 12 healthy newborns and nine children at 6 months were enrolled as control groups (HC). Inferior Longitudinal Fasciculus (ILF), Corpus Callosum Fasciculus (CCF), Corticospinal Tract (CST), Optical Tract (OT), Optic Radiation (OR) were generated in all subjects. DTI parameters were evaluated in basal ganglia (BG), thalamus (TH) and tracks. Statistical analysis was performed with MANOVA. RESULTS: In newborns HIE versus HC, there were significantly lower fractional anisotropy (FA) on OR and CST and higher axial diffusivity (AD), apparent diffusion coefficient (ADC) and radial diffusivity (RD) values on CST, BG and TH in HIE-N. At 6 months there were no significant grouping effects. The analysis showed a significant increase of FA, decrease of ADC, AD, RD after 6 months for HIE and HC. CONCLUSIONS: We observed modifications of parameter values in HIE newborns vs HC; however normalization of values at 6 months suggests that changes of parameters cannot be considered early biomarkers for evaluation of therapeutic hypothermia in newborns with moderate HIE and normal conventional MRI.
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Hipotermia , Hipoxia-Isquemia Encefálica , Anisotropía , Niño , Imagen de Difusión por Resonancia Magnética , Imagen de Difusión Tensora , Humanos , Recién NacidoAsunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Carcinoma Basocelular/tratamiento farmacológico , Neoplasias del Oído/tratamiento farmacológico , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Anciano , Carcinoma Basocelular/patología , Pabellón Auricular/patología , Neoplasias del Oído/patología , Humanos , Masculino , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: Recent studies have shown an increasing incidence of cutaneous adnexal carcinomas (CACs). OBJECTIVES: The aim of our study was to evaluate incidence and survival for cases of CACs and investigate their association with other skin neoplasms. METHODS: We conducted a population-based study. Data on incident cases of CACs were obtained from the Tuscany Cancer Registry between 1985 and 2010. In order to determine whether the occurrence of squamous cell carcinoma (SCC) among patients with CAC is higher or lower than expected in the general population, the standardized incidence ratio (SIR) was calculated. RESULTS: A total of 242 patients with CAC were observed; the age-standardized incidence rate was 3·8 cases per million person-years. From 1997 to 2010 crude incidence rates increased by 159%. Age-specific incidence was higher in men over 80 years old than in women of the same age and younger individuals. Carcinomas of sweat gland origin prevailed; the most common histotype was porocarcinoma and the most frequently affected site was the head/neck. Overall, 88% of CACs were diagnosed at a localized stage. The 5-year overall survival and disease-specific survival rates were 59% [95% confidence interval (CI) 53-65] and 94% (95% CI 91-98), respectively. In the observation cohort, the number of SCCs was significantly higher than expected as the SIR was calculated to be 33·7 (P < 0·001). CONCLUSIONS: Increasing incidence warrants awareness and early diagnosis of CACs. Increased SCC incidence among patients with these tumours highlights the relevance of careful skin examination and follow-up.
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Carcinoma de Apéndice Cutáneo/epidemiología , Carcinoma de Células Escamosas/epidemiología , Costo de Enfermedad , Neoplasias Cutáneas/epidemiología , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Tasa de SupervivenciaRESUMEN
The malignant melanoma is a neoplasm associated with a wide variety of cutaneous paraneoplastic syndromes, as dermatomyositis, systemic sclerosis, paraneoplastic pemphigus. We describe a case of four multiple trichilemmal cystis arising on frontal region in the same patient with brain metastasis and unknown primary melanoma and discuss their relationship.
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Melanoma/patología , Enfermedades de la Piel/patología , Neoplasias Cutáneas/patología , Piel/patología , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/secundario , Humanos , Masculino , Melanoma/complicaciones , Persona de Mediana Edad , Síndromes Paraneoplásicos/complicaciones , Síndromes Paraneoplásicos/patología , Enfermedades de la Piel/complicaciones , Neoplasias Cutáneas/complicacionesRESUMEN
An 85-year-old woman presented with a lesion on the sole of her right foot, which was histologically confirmed as acral lentiginous melanoma. Because of the large field involved and because the patient refused any invasive or painful treatment, topical treatment with imiquimod was commenced. At the 20-month follow-up, the patient was still continuing treatment with topical imiquimod, and no metastases to the lymph nodes or viscera were found, either clinically or in imaging studies. We believe that the success of the treatment cannot be explained only by the stimulation of the immune system induced by imiquimod. A possible explanation might be 'tumour dormancy', where a tumour grows very slowly because of a balance between the neoplasia and the immune (and nonimmune) mechanisms of tumour control. The use of imiquimod has so far allowed our patient to avoid surgery, and perturbation of the mechanisms of tumour regulation, such as local immunity and angiogenesis, has not taken place.
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Aminoquinolinas/administración & dosificación , Antineoplásicos/administración & dosificación , Melanoma/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Administración Tópica , Anciano de 80 o más Años , Femenino , Pie , Humanos , Imiquimod , Melanoma/inmunología , Neoplasias Cutáneas/inmunología , Resultado del TratamientoRESUMEN
BACKGROUND: Patients who develop cutaneous melanoma are at increased risk of developing a second primary melanoma. There are many aetiological reasons by which the risk of a second melanoma increases. Among others, genetic factors may contribute to modulating this risk. The risk of identifying a CDKN2A germline mutation increases with the number of primary melanomas and with the presence of familial history of melanoma. Patients with melanoma are especially encouraged to have regular follow-up visits with their dermatologist to perform clinical and dermatoscopic examination. In particular, dermoscopy could be very useful in multiple primary melanoma (MPM) patients. OBJECTIVES: To analyse the clinical and dermatoscopic features of multiple melanomas, focusing on those features that are more frequently found in the same patient to recognize them earlier and understand whether they appear with the similar peculiar dermatoscopic features, especially in CDKN2A carriers. METHODS: Medical records of MPM patients were selected from a database including 1065 patients with histopathologically proven melanoma diagnosis, all treated at the dermatology clinic of the University of Florence from 2000 to 2013. Pictures of melanoma were independently and blindly administered to three dermatologist experts in dermoscopy to evaluate the presence or absence of ABCD criteria for each clinical image, and the main pattern for the dermoscopic images. The results were then analyzed and crossed to rate the clinical and dermoscopic features of MPM. RESULTS: Seventy five (7.0%) of 1065 patients included in our database were found to carry an MPM disease. Among them, we selected 12 (16%) patients with three or more MPMs. The presence of the CDKN2A melanoma susceptibility gene was observed in 4/12 (33.33%) patients; two patients presented the C500G and c.5 + 1delG polymorphisms in the CDKN2A gene. In CDKN2A carriers, each patient showed a similar and specific dermatoscopic pattern in their lesions. CONCLUSIONS: Even being aware of the limitations of this study, according to hereditary characters and their modes of transmissions, we could speculate that for each patient with a CDKN2A germline mutation, it is possible to find the same kind of dermoscopical pattern among their melanocytic tumours.
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Dermoscopía , Genes p16 , Melanoma/diagnóstico , Mutación , Neoplasias Cutáneas/diagnóstico , Adulto , Anciano , Femenino , Humanos , Masculino , Melanoma/genética , Persona de Mediana Edad , Neoplasias Cutáneas/genéticaRESUMEN
Spontaneous neonatal pneumomediastinum (PNM) is associated with the aspiration of blood or meconium and birth-related trauma and it seems to be more frequent in post-term newborns. It is generally asymptomatic, but it is occasionally accompanied by mild tachypnoea. Only rarely, it requires oxygen therapy or develops into pneumothorax. To evaluate the relationship between the radiological and clinical diagnosis in this uncommon problem, from January 2005 to August 2009, 35 newborns with spontaneous PNM were enrolled in the study. Treatment protocol provides for execution of a chest X-ray, clinical check, SatO(2) and heart rate monitoring. Clinical diagnosis was accomplished particularly early, within the first 24 h of life. Paraphonic and distant tones discovered by cardio-auscultatory exam disappeared within the following 72 h. A total of 28 newborns were asymptomatic (80%); seven were symptomatic (20%); five had transient tachypnoea of the newborn; two developed an RDS, with Silverman score ≥ 3 and required O(2) therapy. It is necessary to affirm the importance of early diagnosis of this condition, carrying out careful monitoring of newborns at risk, to begin timely therapeutic treatments, as oxygen-therapy and to heighten alertness for complications, such as pneumothorax.
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Enfisema Mediastínico/diagnóstico por imagen , Adulto , Femenino , Humanos , Incidencia , Recién Nacido , Masculino , Enfisema Mediastínico/epidemiología , Embarazo , Radiografía , Factores de Riesgo , Ciudad de Roma/epidemiologíaRESUMEN
BACKGROUND: The differential diagnosis between Reed nevi and melanoma becomes more difficult if the lesion to analyse presents a small size, with a diameter of 6 mm or smaller. Many studies have reported various dermoscopic features of Reed nevi during their growth phases. In early stages of evolution, the lesions generally show a characteristic globular appearance typically found in childhood, followed by the so-called starburst pattern. OBJECTIVE: The aim of the study was to identify the main dermoscopic features in small Reed nevi (<6 mm in size). METHODS: Using a computerized skin-imaging database for melanoma prevention surgery at the Department of Dermatology of the University of Florence, 15 Reed nevi were selected among 103 small (<6 mm) melanocytic lesions consecutively excised. Images of small Reed nevi, independently blinded to histopathological diagnosis, were administered to a dermatologist expert in dermoscopy, who separately examined the clinical and the dermatoscopic images of small Reed nevi and evaluated their clinical and dermoscopic parameters. RESULTS: Analysis of the main dermoscopic patterns showed that 40% had a reticular pattern, 20% had a starburst pattern, 6.5% had a globular pattern, 6.5% had a homogeneous pattern and 27% had an atypical pattern. CONCLUSION: We propose that small, early-stage Reed nevus are not characterized by an evolution of growth patterns to a phenotype typical of larger lesions. We assume that the patterns are distributed in a linear manner between age groups, may all be present at the outset and thus are independent from the various stages of nevus development.
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Dermoscopía , Nevo Pigmentado/patología , Neoplasias Cutáneas/patología , Adolescente , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Adulto JovenAsunto(s)
Melanoma/patología , Recurrencia Local de Neoplasia , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: According to the literature, dermatoscopy can improve diagnostic accuracy for melanoma. However, a weak point of the studies in the literature is that most were carried out in a 'privileged' setting of dermatologists who are expert in dermato-oncology, and who work in departments specializing in screening pigmented lesions. This study was set up to specifically evaluate whether the use of dermatoscopy by general dermatologists would also improve accuracy. AIM: To analyse the effect on intention to excise lesions (intervention yes/no) of adding either dermatoscopy (20 years after the advent of the method) or detailed lesion classification (melanoma yes/no) to clinical examination by the naked eye. More specifically, we evaluated whether the current practice of general dermatologists using dermatoscopy improves the sensitivity and specificity values, and thus the diagnostic accuracy. METHODS: Eight general dermatologists examined separately clinical images and combined (clinical and dermatoscopic) images of 200 melanocytic lesions that had been excised (64 melanomas and 136 melanocytic naevi). RESULTS: Focusing on intention to excise (intervention yes/no), addition of dermatoscopy to naked eye examination resulted in an increase in sensitivity for all observers (average gain +4.5%) but an overall nonsignificant reduction in specificity (-4.5%, P=0.10). Diagnostic accuracy, which increased when examination was focused on melanoma (yes/no) classification (+4.1%, P<0.05) remained unchanged (-1.62%; P=0.36). CONCLUSIONS: The effect of adding dermatoscopy to naked eye examination of melanocytic lesions on 'general dermatologists' changes according to the aim of the examination. Dealing with the intention to excise, the increase of sensitivity associated with dermatoscopy (lower risk of leaving a melanoma unexcised) is obtained at the expense of specificity (higher number of melanocytic naevi excised) without improving overall diagnostic accuracy.
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Dermoscopía/normas , Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Competencia Clínica , Diagnóstico Diferencial , Humanos , Melanoma/cirugía , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/cirugía , Examen Físico , Sensibilidad y Especificidad , Neoplasias Cutáneas/cirugíaRESUMEN
BACKGROUND: About 1-2% of infants born to mothers with Graves' disease or Hashimoto's thyroiditis develop neonatal hyperthyroidism because of transplacental passage of IgG stimulating TSH receptors (TRAb). OBJECTIVE: To evaluate the effect of maternal total thyroidectomy on neonatal clinical course. METHODS: We describe two brothers born to a mother with Graves' disease, before and after total thyroidectomy. RESULTS: The first child showed persistent tachycardia, the presence of TRAb and a laboratory pattern of hyperthyroidism. Lugol's solution was started and then propylthiouracil was added. Digitalis, furosemide and diazepam were necessary for treatment of heart failure, hypertension and irritability. On the 70th day of life, hormone serum levels normalized and treatment was interrupted. TRAb normalized by the third month of life. The second infant was born 2 years after the mother underwent total thyroidectomy. In spite of a laboratory pattern of hyperthyroidism and positivity to TRAb, he showed only considerable weight loss, and no therapy was required. CONCLUSIONS: TRAb may persist after total thyroidectomy: clinical and instrumental follow-up of the newborn is recommended.
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Hijo de Padres Discapacitados , Enfermedad de Graves/cirugía , Hipertiroidismo/congénito , Complicaciones del Embarazo/tratamiento farmacológico , Hermanos , Tiroidectomía , Femenino , Enfermedad de Graves/sangre , Enfermedad de Graves/tratamiento farmacológico , Humanos , Hipertiroidismo/sangre , Inmunoglobulinas Estimulantes de la Tiroides/sangre , Recién Nacido , Yoduros/uso terapéutico , Masculino , Evaluación de Resultado en la Atención de Salud , Embarazo , Tiroidectomía/efectos adversos , Factores de TiempoRESUMEN
Many studies have recently analyzed the modulation of the intestinal microflora showing a benefic effects reducing the number of enteritis, improving the oligoelements absorption and stimulating the immunitary system. To do so three way are available: the use of prebiotics, the use of probiotics and the symbiotic way. Prebiotics are non-digestible oligosaccharides that can stimulate selectively the growth bifidogenus bacteria. Probiotics are dietary supplements made of live micro-organisms which improve the microbial environment of the gut. In this review literature is examined the possible efficacy of prebiotics and probiotics in the pediatric age; however, the studies available do not permit to obtain definitive conclusions.