Malattia di Kyrle: eccezionale risposta all’isotretinoina orale

Si presenta il caso di una paziente di 51 anni, affetta da sindrome metabolica, spondiloartrite sieronegativa ed insufficienza renale cronica, afferente al servizio di dermatologia per la presenza di lesioni papulo-nodulari ipercheratosiche follicolari diffuse agli arti ed estremamente pruriginose. Tali lesioni, presenti da alcuni anni, erano state dapprima trattate con terapie topiche (steroidi, antibiotici, retinoidi ed emollienti) con scarso beneficio. A scopo diagnostico veniva eseguita una biopsia cutanea per esame istologico con esito di malattia di Kyrle. Veniva iniziato un ciclo di fototerapia con nb-UVB, poi sospeso per inefficacia. Anche la terapia con metotrexato, impostata per insoddisfacente controllo della patologia reumatologica, non mostrava alcun beneficio sulle manifestazioni cutanee. Veniva dunque intrapresa una terapia con isotretinoina orale 0,5 mg/Kg/die la quale dopo circa 1 anno ha permesso di ottenere una eccezionale e pressoché completa remissione del quadro cutaneo, in assenza di rilevanti effetti collaterali

Multiphoton Laser Microscopy and Fluorescence Lifetime Imaging for the Evaluation of the Skin

Multiphoton laser microscopy is a new, non-invasive technique providing access to the skin at a cellular and subcellular level, which is based both on autofluorescence and fluorescence lifetime imaging. Whereas the former considers fluorescence intensity emitted by epidermal and dermal fluorophores and by the extra-cellular matrix, fluorescence lifetime imaging (FLIM), is generated by the fluorescence decay rate. This innovative technique can be applied to the study of living skin, cell cultures and ex vivo samples. Although still limited to the clinical research field, the development of multiphoton laser microscopy is thought to become suitable for a practical application in the next few years: in this paper, we performed an accurate review of the studies published so far, considering the possible fields of application of this imaging method and providing high quality images acquired in the Department of Dermatology of the University of Modena

Identifying the factors that influence surgeon's compliance with excisional margins of non-melanoma skin cancer

The rising incidence of Non Melanoma Skin Cancers (NMSC) leads to a high number of surgical procedures worldwide. The strict compliance with international guidelines with regard to excisional margins may help decrease the number of re-excision procedures and reduce the risk of NMSC recurrence. The aim of this study was to investigate the prevalence of excisional margins as recommended by the European Academy of Dermatology and Venereology (EADV) and the European Dermatology Forum (EDF) guidelines, and the factors (demographic or clinical) that influence surgeons' compliance with these guidelines.This was a prevalence study looking at surgical excisions of NMSCs performed over a period of 2 years (2011-2012). A sample size of 1669 patients was considered. Definition of excisional margins recommended by the international guidelines (EADV and EDF) were used as point of reference for the analysis. Tumor and histologic specimen size were calculated ex vivo by 5 different pathologists. The size of skin specimens was measured with a major axis and a minor axis. The same was done for the tumor present on the skin specimens. The differences between the major and minor axes of surgical specimen and tumor were calculated. These differences were subsequently divided by two, hypothesizing that the lesion had the same distance from the margins of the surgical specimen. The differences obtained were named "Delta", the formulas applied being the following: Delta major = (major axis specimen-major axis tumor)/2; Delta minor = (minor axis specimen -minor axis tumor)/2.Results show a significant statistical difference, associated with factors such as: Age of the patient, anatomical localization of the tumor, histological diagnosis, and surgeons' experience.The identification of these factors sheds light on clinicians' practice and decision-making regarding excisional margins. Hopefully a higher level of adherence to the guidelines can be achieved in the future

Evaluation de la fibrose myocardique dans la cardiomyopathie hypertrophique (étude moderne par imagerie multimodale)

CONTEXTE: La cardiomyopathie hypertrophique (CMH) est la plus fréquente des maladies myocardiques primitives d'origine génétique et constitue une des causes principales de mort subite du sujet jeune. Selon plusieurs études, la présence de fibrose myodcardique est un facteur indépendant de mauvais pronostic, de survenue de mort subite par troubles du rythme ventriculaire et d'évolution vers l'insuffisance cardiaque. Alors que l'Imagerie par résonnace magnétique cardiaque (IRMc) est à présent le gold-standard pour mette ne évidence la fibrose myocardique, de nouvelles techniques sont en cours d'évaluation telles que l'étude des déformations myocardiques longitudinales (strain longitudinal). OBJECTIF: L'objectif principal était d'analyser la relation entre la quantité de fibrose myocardique ventriculaire gauche mesurée en IRMc et le pic systolique de strain longitudinal quantifié par speckl tracking . Notre hypothèse est que le pic de strain longitudinal est diminué en cas de fibrose myocardique et constitue un paramètre indirect fiable de dépistage de cette fibrose. METHODES: Etude prospectique, monocentrique, observationnelle, incluant consécutivement tous les patients porteur d'une CMH, consultant au sein du Centre de Compétences des cardiomyopathies (Timone-Marseille), de janvier 2012 à janvier 2013. Tous les patients ont bénéficié d'une échocardiographique avec mesure du pic systolique de strain longitudinal global et segmentaire (SLS) et d'une IRMc avec quantification de la fibrose à partir de la séquences de réhaussements tardifs (RT). L'analyse a été menée en régions myocardiques : basale et médianes (la région apicale ayant été exclue). [ ]AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

What Is the Evidence of the Diagnostic Criteria and Screening of Immune Checkpoint Inhibitor–Induced Myocarditis?

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Cancer Therapies and Vascular Toxicities

International audienceOpinion statement Vascular events have become an important issue in the overall management of cancer patients. They usually result from a combination of (i) direct or indirect toxicity of anticancer treatments, (ii) a higher prevalence of cardiovascular risk factors in cancer patients, and (iii) prolonged exposure to treatments due to an increasing patient survival rate. In addition to conventional chemotherapies and radiotherapy, targeted therapies and immunotherapies have been developed which improve the prognosis of cancer patients but sometimes at the cost of vascular toxicity, which can lead to systemic or pulmonary hypertension and arterial/venous thromboembolic events. Endothelial dysfunction, a procoagulant state and metabolic disorders are the three main pathophysiological patterns leading to cancer treatment-related vascular toxicity. This issue is challenging because serious vascular adverse events can necessitate cancer treatment being put on hold or stopped, which could compromise patient survival. In addition to increasing the risk of thrombotic adverse events, cancer therapies may lead to an increased risk of bleeding, especially in treatments with vascular endothelial growth factor inhibitors. Therefore, we can define vasculo-oncology as a part of the cardio-oncology specialty; its aims are to predict, prevent, screen, and treat vascular toxicity related to cancer treatments. While the level of evidence is low regarding the management of vascular toxicity during cancer therapy, cardiologists and specialists in vascular diseases should closely collaborate with oncologists and hematologists to determine the optimal strategy for each patient

Overcoming challenges of immune checkpoint inhibitor-induced myocarditis diagnosis

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Potential of Oncocardiology

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