Real-life effectiveness and safety of baricitinib in patients with severe alopecia areata: A 24-week Italian study.

BACKGROUND: Alopecia areata is an autoimmune condition characterized by rapid hair loss in the scalp, eyebrows and eyelashes, for which treatments are limited. Baricitinib, an oral inhibitor of Janus kinases 1 and 2, has been recently approved to treat alopecia areata. MATERIALS AND METHODS: We conducted a retrospective study involving 23 medical centres across Italy, enrolling patients affected by severe alopecia areata (SALT >50), for more than 6 months. Clinical and trichoscopic assessment was performed at each visit and impact on quality of life, anxiety and depression were evaluated using the Skindex-16 and the Hospital Anxiety and Depression Scale (HADS), respectively. RESULTS: A total of 118 patients were enrolled, with a mean age of 39 years and a mean SALT >95. The mean value of the SALT score decreased from an average of 96.6 (±8.23 sd) to 48 (±35.2 sd) after 24 weeks of treatment and 42.3% of patients achieved a SALT 30, 31.3% a SALT 20 and 20.3% a SALT 10 by Week 24. Trichoscopic signs showed fewer yellow dots and black dots significantly earlier than hair regrowth. Adverse events during the treatment period (mild laboratory test abnormalities) were reported in 12.7% patients. No drop-out were registered. CONCLUSION: Data on the effectiveness and safety of baricitinib are promising and support the use of this drug in severe forms of AA, also in the early stages. We also suggest performing trichoscopy in order to reveal early response to therapy.

Robust and automated three-dimensional segmentation of densely packed cell nuclei in different biological specimens with Lines-of-Sight decomposition.

BACKGROUND: Due to the large amount of data produced by advanced microscopy, automated image analysis is crucial in modern biology. Most applications require reliable cell nuclei segmentation. However, in many biological specimens cell nuclei are densely packed and appear to touch one another in the images. Therefore, a major difficulty of three-dimensional cell nuclei segmentation is the decomposition of cell nuclei that apparently touch each other. Current methods are highly adapted to a certain biological specimen or a specific microscope. They do not ensure similarly accurate segmentation performance, i.e. their robustness for different datasets is not guaranteed. Hence, these methods require elaborate adjustments to each dataset. RESULTS: We present an advanced three-dimensional cell nuclei segmentation algorithm that is accurate and robust. Our approach combines local adaptive pre-processing with decomposition based on Lines-of-Sight (LoS) to separate apparently touching cell nuclei into approximately convex parts. We demonstrate the superior performance of our algorithm using data from different specimens recorded with different microscopes. The three-dimensional images were recorded with confocal and light sheet-based fluorescence microscopes. The specimens are an early mouse embryo and two different cellular spheroids. We compared the segmentation accuracy of our algorithm with ground truth data for the test images and results from state-of-the-art methods. The analysis shows that our method is accurate throughout all test datasets (mean F-measure: 91%) whereas the other methods each failed for at least one dataset (F-measure≤69%). Furthermore, nuclei volume measurements are improved for LoS decomposition. The state-of-the-art methods required laborious adjustments of parameter values to achieve these results. Our LoS algorithm did not require parameter value adjustments. The accurate performance was achieved with one fixed set of parameter values. CONCLUSION: We developed a novel and fully automated three-dimensional cell nuclei segmentation method incorporating LoS decomposition. LoS are easily accessible features that ensure correct splitting of apparently touching cell nuclei independent of their shape, size or intensity. Our method showed superior performance compared to state-of-the-art methods, performing accurately for a variety of test images. Hence, our LoS approach can be readily applied to quantitative evaluation in drug testing, developmental and cell biology.

[Esophageal atresia with distal tracheo-esophageal fistula. Evolution of the treatment in the period of 1955-2000 at the Anna Meyer Children's Hospital of Florence]. / Atresia dell'esofago con fistola esofago-tracheale distale. Evoluzione del trattamento nel periodo 1955-2000 nell'Ospedale Pediatrico Anna Meyer di Firenze.

BACKGROUND: Over the past decades the esophageal atresia (EA) has represented the greatest challenging malformation encountered by the pediatric surgeon. Since then, there have been considerable advancements in the treatment of EA. In this paper the experience at the "Anna Meyer Children's Hospital of Florence" in regards to the surgical treatment of the EA from 1955 to present day is reported, so that the analysis of the various medical and surgical choices followed by the authors and their predecessors in this long period, can be an important learning tool for the EA management. METHODS: From 1955 to 2000, 223 newborns affected by EA with tracheoesophageal fistula (TEF) have been operated on out of a total of 250 cases of EA. Our experience has been subdivided into periods on the basis of homogeneous medical and surgical treatment adopted in that determined time. We have analyzed particularly the data of the last period 1995-2000, where there has been a well standardized protocol of treatment from the medical, surgical and intensive care points of view. RESULTS: The mortality rate has decreased from 44.8 to 3.4% with a significant reduction (p<0.001) between the years 1979-1983 and 1984-2000, due to the introduction of a perioperative treatment in the newborn intensive care unit. Moreover, a significant correlation (p<0.05) has been shown between low birthweight and associated malformations, two risk factors that however do not negatively influence the results of the treatment in the last period 1995-2000. CONCLUSIONS: A full integration between the surgeon and neonatologist is necessary in order to guarantee a good result. The risk connected to EA is not as much the surgical procedure as the presence or absence of associate malformations that are undetected in the prenatal diagnosis. It is suggested that, in order to further reduce the mortality and morbidity rate after EA correction, the number of prenatal diagnoses should be increased.

Laparoscopic decapsulation of a large epidermoid splenic cyst in a child using the UltraCision LaparoSonic Coagulating Shears.

Splenic cysts are rare in pediatric surgery. Congenital epidermoid cysts are exceptional representing only 2.5% of all splenic cysts in childhood. Nowadays, considering the short- and long-term complications of splenectomy in children, the management of epidermoid cyst consists of partial splenectomy or decapsulation of the cystic wall. To our knowledge, the case reported in this article describes the first successful laparoscopic decapsulation of an epidermoid splenic cyst in an 10-year-old child using the UltraCision LaparoSonic Coagulating Shears (LCS). Follow-up at six months confirms no recurrence. Laparoscopic splenic decapsulation provides minimal access and small surgical trauma for treating the cyst while preserving splenic function. The use of UltraCision LCS makes the laparoscopy safely, expeditiously, with minimal blood loss and short hospital stay.

Caval extension of the right renal vein in cadaveric renal transplantation using the ETS 45 endoscopic stapler.

A major technical difficulty encountered with the transplantation of a cadaveric right kidney is due to the short right renal vein. The transplant surgeon usually has two different options to deal with this: the first is to mobilize the external iliac vein, ligating the internal iliac vein and the small retroiliac veins, while the second option is to increase the length of the right renal vein. Right renal vein extension is usually preferred because it is easier to work with. The technique used was to construct a conduit with the vena cava that extends the cadaveric right renal vein using an endoscopic stapler (Ethicon Endopath Linear Cutter ETS45, cod. TSW 45) for thin/vascular tissues. This procedure has been used successfully in 11 of our 155 transplanted patients. We have seen no vascular complications as a result of the stapled conduit of the vena cava. We conclude that the endoscopic stapler for thin/vascular tissues is safe and easy to use in right renal vein extension.

[Intestinal occlusion caused by strangulated Morgagni-Larrey hernia: clinical case and review of the literature]. / Occlusione intestinale da ernia di Morgagni-Larrey strozzata: caso clinico e revisione della letteratura.

Morgagni-Larrey hernia is an infrequent, asymptomatic disease discovered by chance during routine radiological examination. It is usually congenital and non-traumatic even in adults. Nevertheless, it can cause severe disturbances when complicated. We describe a case of strangulated Morgagni-Larrey hernia in a 73-year-old lady admitted to the Emergency Room for abdominal pain, symptoms of intestinal occlusion and respiratory distress. Routine abdominal and chest x-rays revealed herniation of the stomach and transverse colon filling the entire right hemithorax with several air-fluid levels. A CT scan and a water-soluble contrast medium via a nasogastric tube confirmed the presence of the stomach and omentum in the right pleural cavity. Emergency laparotomy permitted reduction of the herniation and treatment of the diaphragmatic defect without resection.

Pressure lavage under ultrasound guidance: a new approach for outpatient treatment of intrauterine adhesions.

OBJECTIVE: To present pressure lavage under ultrasound guidance (PLUG) as a new therapeutic procedure for selected cases of intrauterine adhesions (IUA). DESIGN: An open clinical investigation with no control group. SETTING: Teaching hospital. PATIENT(S): Seven consecutive patients referred to our department for secondary amenorrhea due to IUA. INTERVENTION(S): A newly developed technique based on sonohysterography was used to monitor the effects of intrauterine injections of saline solution on the continuous accumulation of saline in the uterine cavity for the mechanical disruption of IUA. MAIN OUTCOME MEASURE(S): Lysis of intrauterine adhesions, restoration of menses, and increased pregnancy rate in infertile patients. RESULT(S): Five patients with mild IUA obtained satisfactory lysis of adhesions by the use of the PLUG technique. A second-look hysteroscopy after 1 month showed that filmy adhesions persisted in two patients with moderate IUA. These adhesions were removed successfully during hysteroscopy. Restoration of menses was obtained and has continued in all patients. Two of the three infertile patients became pregnant. CONCLUSION(S): This technique is safe and ideal as an in-office procedure. PLUG allows complete lysis in mild IUA cases, and the need for therapeutic, and possibly follow-up hysteroscopy, can be avoided. In moderate IUA cases, the procedure may represent a useful initial step in reducing the need for operative hysteroscopy.

[Use of a Gore-Tex patch in the primary repair of congenital defects of the anterior abdominal wall]. / Impiego di patch di Gore-Tex nella riparazione primaria dei difetti congeniti della parete addominale anteriore.

The surgical treatments for large omphaloceles and gastroschisis have to avoid a dangerous primary fascial closure when it's not feasible, so the pediatric surgeon can use staged surgical procedures that achieve a gradual increase in size of the abdominal cavity. Therefore, a staged approach is mandatory to avoid a complicated reduction and it's the best treatment for large congenital abdominal wall defects. Gore-Tex soft tissue is easy to handle, pliable, soft and well tolerated, so Gore-Tex patch closure is a safe and good alternative to staged repair in large omphaloceles and gastroschisis. The Authors report about five newborns with large congenital abdominal wall defects, in whom primary fascial closure could not be accomplished, so they were successfully treated by primary repair with Gore-Tex patch. The Authors also describe the surgical technique and they reconsider the last surgical techniques for large omphaloceles and gastroschisis.

[The solitary rectal ulcer today. A review of the literature]. / L'ulcera solitaria del retto oggi. Revisione della letteratura.

The solitary rectal ulcer (SRU) is a benign lesion of adults of either sex, which presents with chronic constipation, peculiar defecatory disorders, rectal prolapse and smaller psychological abnormalities. The characteristic appearance of this disease is a "neither being always ulcerate, nor always solitary" lesion, but often with polypoid or granular feature, typically localized in anterior rectal wall, a few inches from anal channel. Distinctive histopathological specimens are localized mucosal distortion, hypertrophic proliferation of muscularis mucosae and obliteration of lamina propria by fibroblasts and muscle fibres from the muscularis mucosae. Very few intermittent or recurrent symptoms are rectal bleeding and mucous discharge with defecations, difficulty of a complete ampullar evacuation and sometimes pelvic or rectoperineal pain. Clinical picture and endoscopic biopsies led to diagnosis. Barium enema, defecography, transrectal ultrasound, manometry and electromyography have an additional role. Medical treatment is performed by high-fiber diet, but biofeedback training is very helpful. Surgical management is as an excisional surgery, as a rectopexy if there is prolapse. Fecal diversion and rectocolic resection are considered only for patients with obstinate and severe symptoms. Even in patients who seem to advocate a surgical approach it is important to heal a dyskinetic puborectalis muscle.

[Gastroduodenal stress ulcer. A pediatric case report]. / L'ulcera gastroduodenale da stress. Descrizione di un caso pediatrico.

The Authors describe a case of a post rubella encephalitis in a six year old child complicated by severe haemorrhagic episodes due to a duodenal stress ulcer. Despite H2 receptors antagonist therapy, surgery has been required to control the repeated bleeding episodes.

[Primary acute acalculous cholecystitis in childhood: a report of 2 clinical cases]. / La colecistite acuta alitiasica primitiva nell'infanzia: descrizione di due casi clinici.

Acute acalculous cholecystitis (AAC) is not frequently encountered in adults and children whether in association with other conditions or above all in primitive form. AAC in infancy, although rare, is well recognized, but its possible presentation is not always kept in mind in considering the differential diagnosis of the acute abdomen. On the other hand, AAC has significant clinical signs and abdominal u.s. scanning usually provides evidence of diagnosis. Only early diagnosis has been shown to limit high morbidity and mortality rates for AAC, since cholecystectomy is the simple procedure of choice for treatment of AAC. We report two cases of primitive AAC one in a six and one in two half years old girls. So we consider the most important features about etiologic factors, pathogenesis, clinical signs and therapy through review of the literature and our personal experience.

[Ectopia cordis and Cantrell's pentalogy: personal experience and considerations on the surgical treatment]. / Ectopia Cordis e Pentalogia di Cantrell: esperienza personale e considerazioni sul trattamento chirurgico.

Clefts of the sternum have always attracted attention whether for pathological and physiological features or for research of surgical correction. Two cases of sternal cleft, one with partial ectopia cordis, the other with Cantrell's pentalogy, are presented. Embryology, strategies and several surgical techniques are discussed on the grounds of personal experience. The pediatric surgeon can make a choice among a lot of surgical techniques, because the ectopia cordis and Cantrell's pentalogy are very uncommon and the surgical treatment has a difficult codification. The knowledge of several methods of surgical correction is necessary to reduce high mortality of ectopia cordis and Cantrell's pentalogy. Primary repair in the neonatal period is the best type of management for these rare conditions, because simple closure of the sternal defect during the first month of life avoids the more complex reconstruction necessary in older children.