Bullous lichen planus and anti-programmed cell death-1 therapy: Case report and literature review.

BACKGROUND: Cutaneous adverse effects of immunotherapies are being seen with increasing frequency in general practice. While anti-PD1 lichenoid reactions are well known, only a few cases of bullous lichen planus have so far been reported in the medical literature. Herein we described a case of secondary bullous lichen planus associated with nivolumab and we present a systematic review of all anti-P1-induced cases reported in the literature. PATIENTS AND METHODS: Three months after beginning treatment with nivolumab for metastatic clear-cell renal carcinoma, a 68-year-old man presented pruritic purplish papules on his limbs that subsequently became bullous. Clinical-histological correlation led us to a diagnosis of secondary bullous lichen planus induced by nivolumab. Systemic steroids and withdrawal of immunotherapy resulted in clinical improvement. REVIEW OF THE LITERATURE: Our systematic review revealed 20 cases of lichen planus induced by anti-PD1 (nivolumab and pembrolizumab) published between 2016 and 2018, 6 of which were of the bullous form. Treatment and maintenance or discontinuation of anti-PD1 were dependent on severity. DISCUSSION: Bullous lichen planus has been reported only rarely in the context of nivolumab therapy. The timeline for development of cutaneous adverse reactions under anti-PD1 immunotherapy may last weeks or months and regular monitoring is required. Withdrawal of immunotherapy should only be considered where the outcome under systemic corticosteroids is unfavourable.

[The efficacy of and tolerance for ketoprofen lysine salt in solution for oropharyngeal use in inflammatory lesions of the oral cavity]. / Efficacia e tollerabilità di ketoprofene sale di lisina in soluzione per uso orofaringeo nelle affezioni flogistiche del cavo orale.

BACKGROUND: A double blind randomized comparative clinical study vs placebo clinical study has been carried out in order to assess the antiinflammatory and analgesic activity of ketoprofen lysine salt in oropharyngeal solution, in pain-inflammatory pathologies of odontostomatological nature. METHODS: One hundred and twenty patients, aged between 18 and 82 years, were recruited for the purpose and assigned at random to treatment with ketoprofen lysine salt or placebo for a period of 7 days. RESULTS AND CONCLUSIONS: Treatment with ketoprofen lysine salt demonstrated a significantly more marked (p < 0.001) anti-inflammatory effect than placebo as regards all variables considered: burning, sensation pain, oedema and erythema, and by the 3rd day of treatment led to significant remission of the symptomatology. Tolerability of ketoprofen lysine salt was excellent.

[Efficacy and tolerability 80 mg granulated ketoprofen lysine salt in posttraumatic orodental pain: double blind vs placebo study]. / Efficacia e tollerabilità di ketoprofene sale di lisina 80 mg granulato in bustine nel dolore post-traumatico in odontostomalogia: studio in doppio cieco vs placebo.

A randomized, double-blind parallel group, placebo-controlled study was carried out in order to evaluate the analgesic and antiin-flammatory activity of ketoprofen lysine salt as granular formulation. Sixty patients undergoing extraction of an impacted third molar were treated orally with 80 mg ketoprofen lysine salt sachet or placebo t.i.d. for 3 days. The inflammation related local signs (pain, flare, local heat and wheal) were evaluated by scores at 1th and 3th day of observation; to study the time-course of analgesic activity, pain intensity was evalauted by Visual Analogic-Scale (VAS) by Scott-Huskisson before and 0.30 minutes, 1, 2, 3, 4, 5, 6, 8 hours after the first administration. Ketoprofen lysine salt was significantly superior to placebo in reducing all inflmamtory signs and symptoms starting from the first day of treatment; the analgesic effect was evident already 30 minutes after administration. Investigator's and patient's global evaluations of efficacy resulted favourable for ketoprofen lysine salt in 96.6% and for placebo in 26.7%. The three adverse events reported were limited to gastric pyrosis (ketoprofen lysine salt, two patients; placebo one patient) and posed no problem to patient management. These data demonstrate the pronouced and rapid analgesic and antinflammatory activity of 80 mg ketoprofen lysine salt granular formulation in post-operative pain and inflammation associated with dental surgery.

[Gastric endoscopic assessment after treatment with orally administered ketoprofen lysine salt (80 mg granular sachet). Controlled study vs placebo]. / Valutazione endoscopica gastrica dopo trattamento con ketoprofene sale di lisina 80 mg granulato in bustine per uso orale. Studio controllato vs placebo.

In this study, a new oral granular formulation of ketoprofen lysine salt, a non steroidal antiinflammatory drug (NSAID) derived from propionic acid, and placebo, were compared for their local effect on the gastric mucosa of healthy, human volunteers. The study was carried out with a double-blind, randomized, parallel-group, design. 10 healthy volunteers were administered one sachet containing 80 mg of ketoprofen lysine salt and 10 volunteers with placebo. The subjects were gastroscoped at baseline and following 10 days drug administration; tolerability was assessed by analysis of the hematology and biochemistry laboratory results, the adverse reaction reports and by the Investigator's and subject's global assessment at the final visit. No symptoms of gastric intolerance were referred in both groups. No statistically significant differences were found between treatments in laboratory results and in final post-treatment tolerability evaluation (Mann-Whitney's test U, Phi and Cramer tests).

A nipple splint.

An easily constructed, inexpensive splint for postoperative maintenance and protection of corrected flat, depressed, or inverted nipples and the method of its use are described.

Jejunal intussusception: a case report and review.

Jejunal intussusception is a rare condition. In contrast to the typical case of ileocolic intussusception, a "lead point" is commonly found that is usually ectopic gastric mucosa. A review of the literature and a case report is presented.