Calcinosis Cutis and Calciphylaxis in Autoimmune Connective Tissue Diseases

Calcinosis represents a severe complication of several autoimmune disorders. Soft-tissue calcifications have been classified into five major types: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. Autoimmune diseases are usually associated with dystrophic calcifications, including calcinosis cutis, occurring in damaged or devitalized tissues in the presence of normal serum levels of calcium and phosphate. In particular, calcinosis cutis has been described in dermatomyositis, polymyositis, juvenile dermatomyositis, systemic sclerosis, systemic lupus erythematosus, primary Sjögren’s syndrome, overlap syndrome, mixed connective tissue disease, and rheumatoid arthritis. Calciphylaxis, a severe and life-threatening syndrome presenting with vascular calcifications and thrombosis, has also been associated with some autoimmune conditions. Due to the potentially disabling character of calcinosis cutis and calciphylaxis, physicians’ awareness about the clinical presentation and management of these diseases should be increased to select the most appropriate treatment option and avoid long-term complications. In this review, we aim to analyze the clinical features of calcinosis cutis and calciphylaxis associated with autoimmune diseases, and the main treatment strategies evaluated up to now for treating this potentially disabling disease

Il cancro del pancreas nell'anziano

Sourcerecord Id Scopus 2176

L'appendicectomia laparoscopica in urgenza

Sourcerecord Id Scopus 2176

Combined approach for the correction of symptomatic rectocele and associated rectal intussusception.

Aim. Rectocele is a frequent asimptomatic finding occurring quite exclusively in women. It can be often associated with a mucosal prolapse or recto-anal intussusception producing the so called “outlet obstruction”. Many approaches are reported with different functional results in order to correct such a defect including transvaginal, transanal, transabdominal and combined techniques and more recently the use of graft materials has been introduced by gynaecologists to reinforce the tissue reconstruction. The use of a combined approach in order to correct both the defects (rectocele and ano-rectal prolapse) has been re-evaluated with the use of a circular stapler to perform an anterior mucosectomy through a transanal approach associated with a posterior colpoperineorrhaphy. Methods. Thirty-six patients suffering from rectocele and associated mucosal prolapse or rectal intussusception underwent single stapler transanal mucosectomy and posterior colpoperineorrhaphy. All patients were female and complained for ano-rectal symptoms of obstructed defecation: they were scheduled by clinical evaluation included Wexner continence score, colpocistodefecography and manometric assessment: The size of rectocele considered was more or equal than 2 cm. After the operation a complete reassessment was performed at six months with a clinical, radiological and manometric evaluation of the results. Moreover all patients were requested to give a subjective evaluation by a short questionnaire. Another follow-up was performed one year after surgery perfprmed. All the results were statistically evaluated. Results. There was a significant improvement of symptoms with a low rate (11%) of persistent incomplete evacuation or perineal heaviness. The need of digitating completely disappeared. There was a little but statistically not significant increase in dyspareunia from 5.5% to 16%. The overall satisfaction grade was very high. A good correspondence between preoperative radiological findings and clinical symptoms was evidenced; in the follow-up colpocistodefecography revealed a persistence of rectocele or mucosal prolapse even in absence of clinical signs of obstructed defecation. Conclusions. A combined transanal and transvaginal approach is an effective treament for the correction of rectocele and associated anorectal intussusception with obstucted defecation simptoms. It provides good results with a low complications rate. Physiological changes in ano-rectal functions after surgery are poor and the subjective statisfaction grade high. Due to the use of a single staplig device it is also less expensive than other transanal operations

Treatment of fistula-in-ano by lift procedure: a preliminary report

Fistulization of the large intestine with the female genital organs is a frequent complication of diverticular disease complicated, and occurs mostly in patients who have previously undergone hysterectomy. Patients typically present with loss of material fecaloid or gas from the vagina, preceded by abdominal pain that resolved with the release of material vaginal. The percentage of fistulas after an episode diverticulitis is less than 5% (1-2%): of these, less than a quarter develops fistulas with the female genital tract, in fact in most cases the fistulization occurs with the bladder. Other possible causes of fistula between the intestinal tract and the genital are: irradiation of the pelvis, neoplasms of colon cancer, inflammatory bowel disease (especially Crohn’s disease). Traditionally, the treatment of fistulas article-genital surgical-type “multi-step”: there are several treatment options guided by the “degree” of diverticular disease and basic organ involved (fallopian tubes, uterus, vagina). Typically using a three-step approach: proximal colostomy followed at a later time by resection and anastomosis tract affection and finally closing the colostomy; or two-step approach with Hartmann’s procedure (resection with colostomy proximal and subsequent restoration of the continuity digestive). Key words: Diverticulitis - Vasovasostomy - Fistula. La creazione di una fistola cologenitale è un evento molto raro, le cause più frequenti possono essere una malattia diverticolare del colon sinistro, una neoplasie dell’utero, postchirurgica negli interventi di isterectomia, post irradiazione della regione pelvica, una malattia infiammatoria cronica intestinale o causata da traumi da corpi estranei. La sintomatologia è caratterizzata soprattutto da dolori addominali, con presenza di uno stato febbrile e perdite fecali dalla vagina. Caso clinico Paziente donna di anni 70, con anamnesi patologica remota positiva per ipertensione arteriosa, HBV positiva, malattia diverticolare del colon ed isterectomia per leiomiosi (circa 20 anni prima). Viene riferita da circa un anno la presenza di improvvisi dolori addominal

La SEPS nel trattamento delle ulcere venose degli arti inferiori. Valutazione dei risultati in base alla classificazione CEAP

Sourcerecord id Scopus: 2394

Primary cutaneous B cell lymphoma, leg type presenting as a diabetic ulcer: A challenging diagnosis

Introduction: A crescent number of reports describe malignant dermal malignancies presenting as diabetic ulcers, such as melanoma, Kaposi's sarcoma, squamous cell carcinoma and cutaneous lymphoma. Methods: The authors reported the clinical and histopathological features of this challenging case of a PCBCL, leg type presenting as a foot ulcer to exemplify the diagnostic difficulties, mainly when, at the onset, this tumour exhibits uncharacteristic features. Case report: A 43 years-old male with a 10-year history of compensated type I diabetes developed an ulcerated 3 cm of diameter tumour on the lateral region of the right foot. This lesion had previously been biopsied and treated as a diabetic neuropathic ulcer elsewhere. Due to the appearance of intralesional necrosis associated with stable inflammation and diabetes laboratory parameters, the clinicians made a provisional clinical diagnosis of pyoderma gangrenosum and performed further two incisional biopsies. Histology showed a clear-cut PCBCL, leg type. Conclusions: Diabetic skin lesions, especially in older patients with persistent non-healing characteristics of pain and tenderness, must be carefully managed through the close correlation of clinical, imaging, and histological features. A correct diagnosis allows avoiding inadequate treatment, which would lead to severe consequences for these patients

Arteriolopatia calcifica uremica: un'entità clinica rara?

Calcific uremic arteriolopathy (Calcyphilaxis): a rare disease? Report of three cases INTRODUCTION: Calcific uremic arteriolopathy (CUA; CALCYPHILAXIS) is a syndrome that occurs prevalently in patients with chronic kidney disease on dialysis. It is characterized by the medial calcification of skin small arteries leading to necrotic lesions. Several risk factors have been identified: obesity, female gender, diabetes mellitus, hyperphosphatemia, inflammation, treatment with vitamin D, calcium-based phosphate binders and warfarin. MATERIALS AND METHODS: We report three cases of CUA observed from October 2011 to September 2014. RESULTS: The mean age at diagnosis was 56 years (range 33-68). Biochemistry showed: mean levels of PTH=1277 pg/ml (range 1000-1696), serum calcium =10.2 mg/dl (range 9.4-11.1), phosphorus=4.5 mg/dl (range 3.4-5.5). All patients were taking vitamin D, two patients were on warfarin therapy. Following actions were undertaken: interruption of calcium-based phosphate binders, vitamin D and warfarin therapy, initiation of cinacalcet and sodium thiosulfate therapy, use of dialysate with lowest available calcium concentration (1.25 mmol/l), Hyperbaric Oxygen Therapy, surgical dressings of skin lesions three times a week. Significant improvement was observed in mean levels of PTH (331 pg/ml, range 200-465), serum calcium (8.3 mg/dl, range 7.4-9.6) and phosphorus (3.4 mg/dl, range 2.6-3.8). In two out of three patients complete healing of ulcerative lesions was obtained. CONCLUSIONS: These cases underline the importance of early diagnosis of CUA especially in patients with concomitant risk factors and careful clinical monitoring, being CUA characterized by a rapid evolution and high mortalit

LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial

Introduction. Milligan-Morgan haemorrhoidectomy performed with LigaSure system (LS) seems to be mainly effective where a large tissue demolition is required. This randomized study is designed to compare LigaSure haemorrohidectomy with conventional diathermy (CD) for treatment of IV-degree haemorrhoids. Methods. 52 patients with IV-degree haemorrhoids were randomized to two groups (conventional diathermy versus LigaSure haemorrhoidectomy). They were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain, day of discharge, early and late complications. The time of recovery of work was also assessed. All patients had a minimum follow-up of twelve months (range 12-24). All data were statistically evaluated. Results. 27 patients were treated by conventional diathermy, 25 by LigaSure. The mean operative time was significantly shorter in LS, such as postoperative pain, mainly lower on the third and fourth postoperative day: moreover pain disappeared earlier in LS than CD. The time off-work was shorter in LS, while there was no difference in hospital stay and overall complications rate. Conclusions. LigaSure is an effective instrument when a large tissue demolition is required. This study supports its use as treatment of choice for IV degree haemorrhoids, even if the procedure is more expansive than conventional operation