Usefulness of bronchoalveolar lavage in suspect COVID-19 repeatedly negative swab test and interstitial lung disease

The diagnosis of coronavirus disease 2019 (COVID-19) relies on nasopharyngeal swab, which shows a 20–30% risk of false negativity [1]. Bronchoalveolar lavage (BAL) is reported to be useful in patients with pulmonary interstitial infiltrates on high-resolution computed tomography (HRCT). We investigated the usefulness of BAL in symptomatic patients with positive HRCT and a repeatedly negative swab test (‘grey zone’)

A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid (FOLFOX-4) as first-line treatment of advanced gastric cancer patients

The aim of the study was to assess the toxicity and the clinical activity of biweekly oxaliplatin in combination with infusional 5-fluorouracil (5-FU) and folinic acid (FA) administered every 2 weeks (FOLFOX-4 regimen) in patients with advanced gastric cancer (AGC). A total of 61 previously untreated AGC patients were treated with oxaliplatin 85 mg m−2 on day 1, FA 200 mg m−2 as a 2 h infusion followed by bolus 5-FU 400 mg m−2 and a 22 h infusion of 5-FU 600 mg m−2, repeated for 2 consecutive days every 2 weeks. All patients were assessable for toxicity and response to treatment. Four (7%) complete responses and 19 partial responses were observed (overall response rate, 38%). Stable disease was observed in 22 (36%) patients, with progressive disease in the other six (10%) patients. Median time to progression (TTP) and median overall survival (OS) were 7.1 and 11.2 months, respectively. National Cancer Institute Common Toxicity Criteria grade 3 and 4 haematologic toxicities were neutropenia, anaemia and thrombocytopenia in 36, 10 and 5% of the patients, respectively. Grade 3 peripheral neuropathy was recorded in three (5%) patients. FOLFOX-4 is an active and well-tolerated chemotherapy. Response rate (RR), TTP and OS were comparable with those of other oxaliplatin-based regimens, suggesting a role for this combination in gastric cancer

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Amiloidosi sistemica AL con prevalente impegno cutaneo

Gli autori riportano il caso di un uomo di 75 aa, giunto all'osservazione per edema persistente del volto, in particolare delle palpebre inferiori, presente da circa otto mesi. Il quadro clinico cutaneo suggestivo, gli esami di laboratorio e l'esame istologico hanno permesso di porre diagnosi di amiloidosi sistemica AL

Nevi e melanomi in particolari sedi cutanee: studio istologico comparativo

L\u2019osservazione clinica di lesioni melanocitiche ha l\u2019obiettivo principale di identificare i melanomi e di asportarli il pi\uf9 precocemente possibile, nelle fasi iniziali, con intento curativo. Poich\ue9 il tasso di mortalit\ue0 correlata a melanoma \ue8 attualmente ancora molto elevato, numerose organizzazioni sanitarie pianificano e organizzano campagne di prevenzione per sensibilizzare l\u2019opinione pubblica circa l\u2019importanza dei controlli regolari periodici delle lesioni cutanee. Nonostante tutti i criteri codificati, la diagnosi differenziale di lesioni melanocitiche benigne e maligne \ue8 spesso difficile. I nevi in alcune localizzazioni particolari presentano atipie cliniche e istologiche che possono simulare il melanoma e condurre, pertanto, a diagnosi errate. Queste sedi sono le aree mammaria, genitale, acrale e quella periflessurale (ascelle, solchi sottomammari, inguine, pube, ombelico). L\u2019obiettivo clinico di questo articolo \ue8 di comprendere come trattare questi nevi atipici; a questo scopo, abbiamo analizzato ed elencato le frequenze di distribuzione delle lesioni melanocitiche benigne e maligne in diversi distretti corporei, prendendo in considerazione l\u2019insorgenza di melanomi in alcune sedi particolari. Per l\u2019analisi statistica, abbiamo considerato 1 241 nevi riscontrati nell\u2019anno 2008 e 490 melanomi diagnosticati in un periodo di tempo di undici anni compreso tra il 1998 e il 2008, in modo tale da confrontare un significativo numero di casi. I risultati dimostrano che, nelle sedi particolari analizzate, il rapporto tra le percentuali della frequenza di distribuzione di nevi e quelle dei melanomi \ue8 sempre superiore a uno (1,5), mentre, nelle altre sedi, essa \ue8 inferiore a uno (0,9). I risultati ottenuti, inoltre, dimostrano che, in questi distretti particolari, il melanoma \ue8 assai meno frequente a differenza dei nevi atipici che invece sono molto frequenti, e che le atipie non sembrerebbero correlare dal punto di vista statistico con queste lesioni

Terra firma forme dermatosis dell\u2019areola

Terra firma forme dermatosis (TFFD), is a dermatosis first described in 1987 by Duncan. It is a benign lesion and looks like a cutaneous localized discoloration that can be removed only by rubbing it with isopropyl alcohol. Its origin is still unknown. Onset can be at any age, sex and region. The differential diagnosis includes many various diseases. This article presents the case of a 16 year-old female patient who had an asyptomatic hyperpigmented linear lesion in her right nipple and areola. The biopsy excluded the linear epidermal nevus. Authors suspected dermatosis neglecta, but they tried to wash the lesion with soap and water without any result. It was easily rubbed off with alcohol, which confirmed the diagnosis of TFFD. Only 17 cases have been published and the present one is the first in which the lesion is localized in the nipple in a linear pattern. As recently nine cases of cloracne, whose pathogenesis of is almost known, have been diagnosed and some histological similarities with TFFD have been noticed, the authors provide a possible pathogenesis of the latter as it is still remains unknown. Dermatologists should be aware of this dermatosis. Despite the fact that it has such a simple treatment, it is often under-diagnosed