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Crippa J, Magistro C, Montroni I, Borroni G, Ziccarelli A, Spinelli A, Mari GM. Charting connections: A systematic review of colorectal surgery research networks. Eur J Surg Oncol 2024; 50:108322. [PMID: 38653161 DOI: 10.1016/j.ejso.2024.108322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Research in surgery faces intrinsic difficulties such as the lack of reproducibility of surgical operations, self-referring surgeons, decentralized data. Establishing a community of qualified researchers across surgeons is crucial. Clinical networks have been proposed as solutions to many challenges in surgical research, yet their implementation remains uncommon, especially for surgical trialists. The extent of literature produced by networks remains unclear, but fostering such collaborations could enhance the overall quality of surgical research. We conducted review focusing on research networks in colorectal surgery to assess their workload and impact in the literature and identify factors contributing to their durability. Following PRISMA guidelines, we searched for articles published through research networks. Networks were categorized by subspecialty, and specific items were retrieved for further classification. A survey was administered to twenty experts in colorectal surgery or research networking. A total of 2490 manuscripts were screened, and 397 networks identified. Of these, 96 were colorectal networks contributing to 492 publications, with 28 networks having five or more publications. Seventeen networks were affiliated with International or National societies, and only 5 conducted both prospective trials and RCTs. Twenty networks reported national or population-based data, and 26 networks lasted for more than 5 years. Sixteen experts participated in the survey, with an 80 % compliance rate, and 12 of them have been involved in creating a surgical network. The large majority of experts advocate the establishment of guidelines for networks creation in the surgical community.
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Affiliation(s)
- Jacopo Crippa
- Department of General Surgery, ASST Melegnano e Martesana, Via Pandina 1, Vizzolo Predabissi, Milan, 20070, Italy; AIMS Academy Clinical Research Network, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Carmelo Magistro
- Department of General Surgery, ASST Melegnano e Martesana, Via Pandina 1, Vizzolo Predabissi, Milan, 20070, Italy; AIMS Academy Clinical Research Network, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Giacomo Borroni
- AIMS Academy Clinical Research Network, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Chirurgia Generale Varese 1, ASST Settelaghi, Viale Borri 57, 21100, Varese, Italy
| | - Antonio Ziccarelli
- AIMS Academy Clinical Research Network, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; General Surgery Department, ASUFC, Via Pozzuolo n° 330, 33100, Udine, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulio Maria Mari
- AIMS Academy Clinical Research Network, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Colorectal Surgery, ASST Brianza, 20832, Viale Mazzini 1, Desio, MB, 20832, Italy
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Mari G, Crippa J, Montroni I, Maggioni D, Calini G, Totis M, Tamini N, Oldani M, Cocozza E, Berselli M, Borroni G, Magistro C, Ferrari G, Achilli P, Petri R, Ziccarelli A, Crestale S, Bagnardi V, Peveri G, Origi M. MRI-Pathology Agreement in Rectal Cancer: Real-World Data from a Prospective Rectal Cancer Registry. Chirurgia (Bucur) 2021; 116:583-590. [PMID: 34749854 DOI: 10.21614/chirurgia.116.5.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 11/23/2022]
Abstract
Introduction: Magnetic Resonance Imaging (MRI) is routinely used in preoperative rectal cancer staging. The concordance of MRI staging with final pathologic exam, albeit improved, has not yet reached perfection. The aim of this study is to analyze the agreement between MRI and pathologic exam in patients operated on for mid-low rectal cancer. Material and Method: Patients undergoing neoadjuvant chemoradiation therapy (nCRT) or upfront surgery were analyzed. Between January 2019 to December 2019, 140 patients enrolled in the AIMS Academy rectal cancer registry were analyzed. Sixty-two patients received nCRT and 78 underwent upfront surgery. Results: Overall, the agreement between MRI and pathologic exam on T stage and N stage were 64.7% and 69.2%, respectively. The agreement between MRI and pathologic exam on T stage was 62.7% for patients who did not receive nCRT and 67.4% for patients who received nCRT (p = 0.62). The agreement on N stage was 76.3% for patients who did not receive nCRT and 60.0% for patients who received nCRT (p = 0.075). Conclusions: Real-world data shows MRI is still far from being able to correlate with the pathology findings which raises questions about the accuracy of the real-life decision-making process during cancer boards.
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Mari GM, Crippa J, Pietro A, Maggioni D, Costanzi A, Scotti MA, Braga M, Cocozza E, Borroni G, Benzoni I, Totaro L, Origi M, Ferrari G, Ziccarelli A, Petri R, Bagnardi V. Is BMI a Factor in Compliance to Adjuvant Chemotherapy for Locally Advanced Rectal Cancer? Chirurgia (Bucur) 2021; 116:51-59. [PMID: 33638326 DOI: 10.21614/chirurgia.116.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Compliance to adjuvant chemotherapy (AC) for patients undergoing rectal surgery ranges from 43% to 73.6%. Reasons reported for not initiating or completing AC include onset of postoperative complications, drug toxicity, disease progression and/or patient preferences. Little is known regarding the impact of obesity on the compliance to AC in this setting.
Methods: This multicenter, retrospective study analyzed compliance to AC and treatment-related morbidity in 511 patients having undergone surgery with curative intent for rectal cancer in six Italian colorectal centers between January 2013 and December 2017.
Results: 70 patients were obese (BMI 30 kg/m2). The proportion of open procedures (22.9% vs. 13.4%) and conversions (14.3% vs. 4.8%) was greater in obese compared to non-obese patients (p 0.001). Median hospital stay was one day longer for obese patients (9 days vs. 10 days, p=0.038) while there was no statistically significant difference in the complication rate, whether overall (58.6% in obese vs. 52.3% in non-obese) or with a Clavien-Dindo score 3 (17.1% vs 10.9%). AC was offered to 49/70 (70%) patients in the obese group and 306/441 (69.4%) in the non-obese group (p=0.43). There was no statistically significant difference in AC compliance: 18.4% and 22.9% did not start AC, while 36.7% and 34.6%, started AC but did not complete the scheduled treatment (p=0.79) in the obese and non-obese group, respectively. Overall, 55% of patients who started AC successfully completed their adjuvant treatment.
Conclusions: Obesity did not impact compliance to AC for locally advanced rectal cancer: compliance was poor in obese and non-obese patients with no statistically significant difference between the two groups. Major complication rate was not statistically significantly affected by increased BMI.
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Mari GM, Crippa J, Achilli P, Montroni I, Ugolini G, Taffurelli G, Cocozza E, Borroni G, Valenti F, Roscio F, Ferrari G, Origi M, Zuliani W, Pugliese R, Costanzi ATM, Fingherut A, Maggioni D. High Versus Low Ligation of the Inferior Mesenteric Artery During Rectal Resection for Cancer: Oncological Outcomes After Three Years of Follow-Up From the HIGHLOW Trial. Ann Surg Open 2020; 1:e017. [PMID: 37637440 PMCID: PMC10455194 DOI: 10.1097/as9.0000000000000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives To determine the disease-free survival (DFS), disease-specific survival (DSS), and recurrence in patients who underwent laparoscopic low anterior rectal resection with total mesorectal excision (TME) with either high or low ligation of the inferior mesenteric artery (IMA). Background The level of IMA ligation during anterior rectal resection with TME is still a matter of debate, especially in terms of oncological adequacy. Methods Between June 2014 and December 2016, patients scheduled to undergo elective laparoscopic low anterior resection (LAR) and TME in 6 Italian nonacademic hospitals were randomized into 2 groups in the HIGHLOW Trial (ClinicalTrials.gov Identifier: NCT02153801) according to the level of IMA ligation: high ligation (HL) versus low ligation (LL). DFS, DSS, and recurrence were inquired. Recurrence was determined at 3, 6, 9, and 12 months and every 6 months thereafter. Patients and tumor characteristics as well as surgical outcomes were analyzed to identify risk factors for recurrence. Results One hundred ninety-six patients from the HIGHLOW trial were analyzed. Median follow-up for DFS was 40.6 (interquartile range [IQR], 6-64.7) and 40 (IQR, 7.6-67.8), while median follow-up for DSS was 41.2 (IQR, 10.7-64.7) and 42.7 (IQR, 6-67.6) in the HL and LL groups, respectively. The 3-year DFS rate of HL and LL patients was 82.2% and 82.1% (P = 0.874), respectively. The 3-year DSS for HL and LL patients was 92.1% and 93.4% (P = 0.897), respectively. There was no statistically significant difference in the local recurrence rate (2% HL vs 2.1% LL), in the regional recurrence rate (3% HL vs 2.1% LL), and in the distant recurrence rate (12.9% HL vs 13.7% LL). Multivariate analysis found conversion to open surgery (hazard ratio [HR], 3.68; P = 0.001) and higher stage of disease (HR, 7.73; P < 0.001) to be significant determinant for DFS. Conclusions The level of inferior mesenteric artery ligation during LAR and TME for rectal cancer does not affect DFS, DSS, and recurrence.
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Affiliation(s)
- Giulio M. Mari
- From the Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Desio MB, Italy
| | - Jacopo Crippa
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Pietro Achilli
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Isacco Montroni
- Colorectal Surgery, Department of Surgery, Ospedale per gli Infermi Faenza, Faenza, Italy
| | - Giampaolo Ugolini
- Colorectal Surgery, Department of Surgery, Ospedale per gli Infermi Faenza, Faenza, Italy
| | - Giovanni Taffurelli
- Colorectal Surgery, Department of Surgery, Ospedale per gli Infermi Faenza, Faenza, Italy
| | - Eugenio Cocozza
- ASST Sette Laghi, Surgical Oncology and Minimally Invasive Unit, Varese, Italy
| | - Giacomo Borroni
- ASST Sette Laghi, Surgical Oncology and Minimally Invasive Unit, Varese, Italy
| | | | - Francesco Roscio
- Division of General Surgery, ASST Sette Laghi, Galmarini Hospital, Tradate VA, Italy
| | - Giovanni Ferrari
- Division of Oncologic and Mini-Invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Origi
- Division of Oncologic and Mini-Invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Walter Zuliani
- Humanitas Mater Domini Clinical Institute, General Surgery, Castellanza VA, Italy
| | | | - Andrea T. M. Costanzi
- General Surgery Department, ASST Lecco, San Leopoldo Mandic Hospital, Merate, Italy; and
| | - Abe Fingherut
- Surgical Research, Department of Surgery, Medical University of Graz, Austria and Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, People’s Republic of China
| | - Dario Maggioni
- From the Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Desio MB, Italy
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Berselli M, Borroni G, Livraghi L, Quintodei V, Sambucci D, Cortelezzi C, Segato S, Carcano G, Cocozza E. Laparoscopic Approach to Large Bowel Neoplastic Obstruction After Self-Expandable-Metal-Stent (SEMS) Placement. Surg Laparosc Endosc Percutan Tech 2019; 29:133-137. [PMID: 30629036 DOI: 10.1097/sle.0000000000000623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Endoscopic self-expandable metal stent (SEMS) placement as a bridge to surgery in large bowel neoplastic obstruction is an alternative to emergency surgery for the obstructive colorectal neoplasms. This study aims to analyze postoperative and long-term outcomes in a series of patients who underwent laparoscopic colorectal resection after SEMS placement. The analysis, after the stratification based on the time elapsed between the onset of the occlusive symptoms and the SEMS positioning, revealed an interesting result, with lower mortality for patients who underwent the procedure within 24 hours of hospitalization (P=0.0159). This trend may indicate the need to reduce the endoscopic time schedules as much as possible, even if an emergency procedure is needed. The laparoscopic approach, after stent placement as bridge therapy, can be a safe alternative to emergency surgery, if the procedure is precociously applied.
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Affiliation(s)
- Mattia Berselli
- Department of Surgery, Surgical Oncology and Minimally Invasive Division
| | - Giacomo Borroni
- Department of Surgery, Surgical Oncology and Minimally Invasive Division
| | - Lorenzo Livraghi
- Department of Surgery, Surgical Oncology and Minimally Invasive Division
| | - Valeria Quintodei
- Department of Surgery, Surgical Oncology and Minimally Invasive Division
| | - Daniele Sambucci
- Department of Surgery, Surgical Oncology and Minimally Invasive Division
| | - Claudio Cortelezzi
- Department of Specialist Medicine, Gastroenterology Division, ASST Settelaghi
| | - Sergio Segato
- Department of Specialist Medicine, Gastroenterology Division, ASST Settelaghi
| | - Giulio Carcano
- Research Centre for Trauma and Emergency Surgery, University of Insubria, Varese, Italy
| | - Eugenio Cocozza
- Department of Surgery, Surgical Oncology and Minimally Invasive Division
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Mari GM, Achilli P, Maggioni D, Crippa J, Costanzi ATM, Scotti MA, Giardini V, Garancini M, Cocozza E, Borroni G, Benzoni I, Martinotti M, Totaro L, Origi M, Mazzola M, Ferrari G, Ziccarelli A, Petri R, Bagnardi V, Pugliese G, Forgione A, Pugliese R. Creation of a rectal cancer registry in Italy by the Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network. F1000Res 2019; 8:1736. [PMID: 31723425 PMCID: PMC6833985 DOI: 10.12688/f1000research.20702.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
Abstract
Background: The management of rectal cancer is multimodal and involves a multidisciplinary team of cancer specialists with expertise in medical oncology, surgical oncology, radiation oncology and radiology. It is crucial for highly specialized centers to collaborate via networks that aim to maintain uniformity in every aspect of treatment and rigorously gather patients’ data, from the first clinical evaluation to the last follow-up visit. The Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network aims to create a rectal cancer registry. This will prospectively collect the data of patients operated on for non-metastatic rectal cancer in high volume colorectal surgical units through a well design pre-fashioned database for non-metastatic rectal cancer, in order to take all multidisciplinary aspects into consideration. Methods/Design: The protocol describes a multicenter prospective observational cohort study, investigating demographics, frailty, cancer-related features, surgical and radiological parameters, and oncological outcomes among patients with non-metastatic rectal cancer who are candidates for surgery with curative intent. Patients enrolled in the present registry will be followed up for 5 years after surgery. Discussion: Standardization and centralization of data collection for neoplastic diseases is a virtuous process for patient care. The creation of a register will allow the control of the quality of treatments provided and permit prospective and retrospective studies to be carried out on complete and reliable high quality data. Establishing data collection in a prospective and systematic fashion is the only possibility to preserve the enormous resource that each patient represents.
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Affiliation(s)
- Giulio M Mari
- General Surgery Department, Desio Hospital, Desio, Italy
| | - Pietro Achilli
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Dario Maggioni
- General Surgery Department, Desio Hospital, Desio, Italy
| | - Jacopo Crippa
- General Surgery Residency Program, University of Milan, Milan, Italy
| | | | - Mauro A Scotti
- General Surgery Department, San Gerardo Hospital, Monza, Italy
| | | | | | | | | | | | | | - Luigi Totaro
- Department of Surgery, Cremona Hospital, Cremona, Italy
| | - Matteo Origi
- General Surgery Department, Niguarda Hospital, Milan, Italy
| | | | | | | | - Roberto Petri
- General Surgery Department, AOU "SSMM della Misericordia", Udine, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Giacomo Pugliese
- AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy
| | | | - Raffaele Pugliese
- AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy
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Mari GM, Maggioni D, Crippa J, Costanzi ATM, Scotti MA, Giardini V, Garancini M, Cocozza E, Borroni G, Benzoni I, Martinotti M, Totaro L, Origi M, Mazzola M, Ferrari G, Achilli P, Ziccarelli A, Martino A, Petri R, Botta F, Bagnardi V, Pugliese G, Forgione A, Pugliese R. Compliance to Adjuvant Chemotherapy of Patients Who Underwent Surgery for Rectal Cancer: Report from a Multi-institutional Research Network. World J Surg 2019; 43:2544-2551. [PMID: 31240433 DOI: 10.1007/s00268-019-05060-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Adjuvant chemotherapy for locally advanced rectal cancer is associated with improved overall survival. However, recent evidence from randomized trials showed a compliance rate of 43 to 73%, which may affect efficacy. The aim of this multicenter retrospective analysis was to investigate the compliance rate to adjuvant treatment for patients who underwent rectal surgery for cancer. METHODS Patients who underwent surgery with curative intent for rectal cancer in six Italian colorectal centers between January 2013 and December 2017 were retrospectively reviewed. Exclusion criteria were age less than 18 years, palliative or emergency surgery, and stage IV disease. Parameters of interest were patients' characteristics, preoperative tumor stage, neo-adjuvant chemoradiation therapy, intra-operative and postoperative outcomes. Although the participating centers referred to the same treatment guidelines for treatment, the chemotherapy regiment was not standardized across the institutions. Reasons for not starting adjuvant chemotherapy when indicated, interruption, and modification of drug regimen were collected to investigate compliance. RESULTS A total of 572 patients were included in the analysis. Two hundred and fifty-two (44.1%) patients received neo-adjuvant chemoradiation therapy. All patients underwent high anterior rectal resection, low anterior rectal resection, or Miles' procedure. Of 399 patients with an indication to adjuvant chemotherapy, 176 (44.1%) completed the treatment as planned. Compliance for patients who started chemotherapy was 56% (95% CI 50.4-61.6%). Sixty-six patients interrupted the treatment, 76 patients significantly reduced the drug dose, and 41 patients had to switch to other therapeutic regimens. CONCLUSIONS The present multicenter investigation reports a low compliance rate to adjuvant chemotherapy after rectal resection for cancer. Multidisciplinary teams should focus on future effort to improve compliance for these patients.
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Affiliation(s)
- Giulio M Mari
- General Surgery Department, Desio Hospital, ASST Monza, Desio, MB, Italy
| | - Dario Maggioni
- General Surgery Department, Desio Hospital, ASST Monza, Desio, MB, Italy
| | - Jacopo Crippa
- General Surgery Residency Program, University of Milan, Via Festa del Perdono, 7, 20100, Milan, Italy.
| | | | - Mauro A Scotti
- General Surgery Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Vittorio Giardini
- General Surgery Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Mattia Garancini
- General Surgery Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Eugenio Cocozza
- General Surgery Department, Varese Hospital, ASST Settelaghi, Varèse, Italy
| | - Giacomo Borroni
- General Surgery Department, Varese Hospital, ASST Settelaghi, Varèse, Italy
| | - Ilaria Benzoni
- Department of Surgery, Cremona Hospital, ASST Istituti Ospitalieri Cremona, Cremona, Italy
| | - Mario Martinotti
- Department of Surgery, Cremona Hospital, ASST Istituti Ospitalieri Cremona, Cremona, Italy
| | - Luigi Totaro
- Department of Surgery, Cremona Hospital, ASST Istituti Ospitalieri Cremona, Cremona, Italy
| | - Matteo Origi
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
| | - Michele Mazzola
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
| | - Pietro Achilli
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
| | | | - Antonio Martino
- General Surgery Department, AOU "SSMM della Misericordia", Udine, Italy
| | - Roberto Petri
- General Surgery Department, AOU "SSMM della Misericordia", Udine, Italy
| | - Francesca Botta
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | | | - Antonello Forgione
- General Surgery Department, Niguarda Hospital, ASST Grande ospedale metropolitano Niguarda, Milan, Italy
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Mari GM, Crippa J, Borroni G, Cocozza E, Roscio F, Scandroglio I, Origi M, Ferrari G, Forgione A, Riggio V, Pugliese R, Costanzi ATM, Maggioni D. Symptomatic Uncomplicated Diverticular Disease and Incidence of Unexpected Abscess during Sigmoidectomy: A Multicenter Prospective Observational Study. Dig Surg 2019; 37:199-204. [PMID: 31117071 DOI: 10.1159/000500084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/31/2019] [Indexed: 12/10/2022]
Abstract
BACKGROUND Symptomatic uncomplicated diverticular disease can affect patients' everyday routine. Considerable efforts have been made to identify clinical features that correlate to the severity of the disease. Unexpected intraoperative abscesses are reported in large retrospective series, showing how uncomplicated symptoms and presentations can underlie a complicated disease. The aim of this study was to investigate the incidence of pericolic or intramural abscess in patients undergoing elective sigmoidectomy for symptomatic uncomplicated diverticular disease and see if chronic symptoms correlate to the presence of an abscess. METHODS Between January 2016 and June 2018, we prospectively collected data of patients who were given indication to elective sigmoidectomy for symptomatic uncomplicated diverticular disease. Patients were divided into 3 groups: acute resolving, smoldering, and atypical according to a previously described classification of uncomplicated diverticular disease. RESULTS One hundred fifty-eight consecutive patients were enrolled in the study. The median age was 63 years (22- 88), and the mean body mass index was 26 (±7) kg/m2. There were 114 patients in the acute resolving group, 36 in the smoldering group, and 8 in the atypical group. An unexpected abscess was reported in 75 patients (47.5%) during surgery or pathological examination. The incidence of -abscess was greater for patient in the smoldering group (p = 0.0243). CONCLUSION Our series of patients affected by symptomatic uncomplicated diverticular disease showed an incidence of unexpected pericolic or intramural abscess of 47.5%. Patients affected by smoldering diverticular disease presented a greater abscess rate.
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Affiliation(s)
- Giulio M Mari
- Department of Laparoscopic and Oncological General Surgery, ASST Monza, Desio Hospital, Desio, Italy
| | - Jacopo Crippa
- General Surgery Residency Program, University of Milan, Milan, Italy,
| | - Giacomo Borroni
- Surgical Oncology and Minimally Invasive Unit, ASST Settelaghi, Varese, Italy
| | - Eugenio Cocozza
- Surgical Oncology and Minimally Invasive Unit, ASST Settelaghi, Varese, Italy
| | - Francesco Roscio
- Division of General Surgery, ASST Sette Laghi, Galmarini Hospital, Tradate, Italy
| | - Ildo Scandroglio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio General Hospital, Busto Arsizio, Italy
| | - Matteo Origi
- Division of Oncologic and Mini-invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- Division of Oncologic and Mini-invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonello Forgione
- Division of Oncologic and Mini-invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valentina Riggio
- Department of Laparoscopic and Oncological General Surgery, ASST Monza, Desio Hospital, Desio, Italy
| | | | - Andrea T M Costanzi
- Department of Laparoscopic and Oncological General Surgery, ASST Monza, Desio Hospital, Desio, Italy
| | - Dario Maggioni
- Department of Laparoscopic and Oncological General Surgery, ASST Monza, Desio Hospital, Desio, Italy
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9
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Vassallo C, Rivetti N, Merlino M, Borroni G, Brazzelli V. Effectiveness of surgical treatment of severe macrocheilia in a patient with orofacial granulomatosis. Clin Exp Dermatol 2017; 42:887-889. [PMID: 28748609 DOI: 10.1111/ced.13201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
Orofacial granulomatosis (OFG) is the term given to a group of diseases characterized by the presence of non-necrotizing granulomatous inflammation affecting the soft tissues of the orofacial region. Treatment of OFG is often challenging and unsatisfactory. We report on a 32-year-old man with a 2-year history of oedema and swelling of the upper lip without systemic symptoms. The history, clinical features and histopathological findings led to the diagnosis of cheilitis granulomatosa (CG), a disease included in the spectrum of OFG. The patient was treated with oral diaminodiphenyl sulfone (DDS) and clofazimine without success. Oral doxycycline led to a slight improvement of the disease. Because the volume of the upper lip was twice normal size, surgical reduction was performed, followed by administration of oral doxycycline for 3 months. This therapeutic approach led to complete remission, with no recurrence after 3 years.
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Affiliation(s)
- C Vassallo
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - N Rivetti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - M Merlino
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Borroni
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - V Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Frattini F, Borroni G, Lavazza M, Liu X, Kim HY, Liu R, Anuwong A, Rausei S, Dionigi G. New endoscopic procedures for diabetes mellitus type 2 and obesity treatment. Gland Surg 2016; 5:458-464. [PMID: 27867859 DOI: 10.21037/gs.2016.10.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity continues to be a growing epidemic worldwide. Obese patients have severe comorbidities that make risky and technically demanding the execution of bariatric surgery from both surgical and anesthetic point of view; therefore, the focus of bariatric surgeons is increasingly moving towards minimally invasive, endoscopic techniques. METHODS The present review presents and discusses recent endoscopic techniques employed in obesity treatment, their features and results. RESULTS Endoscopic treatment can be primary or revisional; we can mainly divide the endoscopic devices into five categories: space-occupying devices, restrictive procedures, bypass liner, aspiration therapy and endoscopic revision of gastric bypass for dilated gastric pouch. CONCLUSIONS Endoscopic treatments for obesity are promising techniques for selected patients but each procedure should be tailored on the patient in a multimodal approach.
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Affiliation(s)
- Francesco Frattini
- Department of General Surgery, Endocrine Surgery Center, University of Insubria Varese, Varese, Italy
| | - Giacomo Borroni
- Department of General Surgery, Endocrine Surgery Center, University of Insubria Varese, Varese, Italy
| | - Matteo Lavazza
- Department of General Surgery, Endocrine Surgery Center, University of Insubria Varese, Varese, Italy
| | - Xiaoli Liu
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Hoon Yub Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Korea
| | - Renbin Liu
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Angkoon Anuwong
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Stefano Rausei
- Department of General Surgery, Endocrine Surgery Center, University of Insubria Varese, Varese, Italy
| | - Gianlorenzo Dionigi
- Department of General Surgery, Endocrine Surgery Center, University of Insubria Varese, Varese, Italy
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11
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Brazzelli V, Rivetti N, Croci GA, Barbarini G, Vassallo C, Paulli M, Borroni G. Long-term remission of erythrodermic mycosis fungoides after persistent control of hepatitis B infection. J Eur Acad Dermatol Venereol 2016; 31:e108-e110. [PMID: 27422529 DOI: 10.1111/jdv.13837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - N Rivetti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G A Croci
- Anatomic Pathology Unit, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Barbarini
- Division of Tropical Medicine, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - C Vassallo
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - M Paulli
- Anatomic Pathology Unit, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Borroni
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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12
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Brazzelli V, Barbagallo T, Prestinari F, Rona C, De Silvestri A, Trevisan V, Borroni G. Non-Invasive Evaluation of Tacalcitol Plus Puva versus Tacalcitol Plus UVB-NB in the Treatment of Psoriasis: “Right-Left Intra-Individual — Pre/Post Comparison Design”. Int J Immunopathol Pharmacol 2016; 18:755-60. [PMID: 16388725 DOI: 10.1177/039463200501800419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Photochemotherapy with psoralen plus ultraviolet A (PUVA) and phototherapy with UVB narrow band (UVB-NB) are used in the treatment of psoriasis. Numerous studies have shown that the additional administration of either topical or systemic antipsoriatic agents may effectively increase the efficacy of these therapies. This study aimed to compare through objective data the efficacy of topical tacalcitol in combination with PUVA or UVB-NB versus PUVA and UVB-NB monotherapy in the treatment of mild to moderate chronic plaque psoriasis. Modified Psoriasis Area and Severity Index (PASI) score, transepidermal water loss (TEWL) and stratum corneum hydration were used to monitor the restoration of skin barrier in the psoriatic plaques of 40 patients during photochemotherapy. The study was a right-left, intra-individual, pre/post comparison trial. PUVA and UVB-NB treatments were given three times a week. On those plaques localized on the right side of the body tacalcitol ointment was applied once a day, in the evening. Corneometry, TEWL and modified PASI score were used to evaluate the response to the treatment at baseline, one month and two months. Thirty-six of the forty enrolled subjects completed the study. The comparison between combination treatments and the PUVA/UVB-NB monotherapy showed no significant differences with regard to modified PASI index. However, significant differences were recorded with regard to TEWL and corneometry. The combination of tacalcitol plus PUVA or tacalcitol plus UVB-NB restored epidermal barrier functions as well as skin hydration faster than PUVA or UVB-NB monotherapy (TEWL: p=0.0050 and corneometry: p=0.003). The combination of tacalcitol plus UVB-NB allowed a better restoration of skin barrier functions than tacalcitol plus PUVA (p=0.013). In conclusion, the combination of tacalcitol plus PUVA or plus UVB-NB improves the therapeutic result. In addition, the data from TEWL and skin hydration suggest a means in which tacalcitol plus UVB-NB induces a better normalization of skin biophysical parameters.
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Affiliation(s)
- V Brazzelli
- Department of Human and Hereditary Pathology, Institute of Dermatology, University of Pavia, Italy.
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13
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Brazzelli V, Rivetti N, Carugno A, Barruscotti S, Croci GA, Perani G, Borroni G. Eruptive xanthomas after extensive tattooing: a case report and literature review. GIORN ITAL DERMAT V 2015; 150:770-771. [PMID: 25014584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- V Brazzelli
- Department of Clinical and Surgical Diagnostic and Pediatric Sciences, Dermatology Clinic, University of Pavia and Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy -
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14
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Brazzelli V, Grasso V, Elena C, Orlandi E, Borroni G. Unusual widespread cutaneous eruption due to nilotinib therapy for chronic myeloid leukemia. GIORN ITAL DERMAT V 2015; 150:623-625. [PMID: 25014583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- V Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy -
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15
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Saredi G, Pirola GM, Pacchetti A, Lovisolo JA, Borroni G, Sembenini F, Marconi AM. Evaluation of the learning curve for thulium laser enucleation of the prostate with the aid of a simulator tool but without tutoring: comparison of two surgeons with different levels of endoscopic experience. BMC Urol 2015; 15:49. [PMID: 26055885 PMCID: PMC4459696 DOI: 10.1186/s12894-015-0045-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 06/02/2015] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to determine the learning curve for thulium laser enucleation of the prostate (ThuLEP) for two surgeons with different levels of urological endoscopic experience. Methods From June 2012 to August 2013, ThuLEP was performed on 100 patients in our institution. We present the results of a prospective evaluation during which we analyzed data related to the learning curves for two surgeons of different levels of experience. Results The prostatic adenoma volumes ranged from 30 to 130 mL (average 61.2 mL). Surgeons A and B performed 48 and 52 operations, respectively. Six months after surgery, all patients were evaluated with the International Prostate Symptom Score questionnaire, uroflowmetry, and prostate-specific antigen test. Introduced in 2010, ThuLEP consists of blunt enucleation of the prostatic apex and lobes using the sheath of the resectoscope. This maneuver allows clearer visualization of the enucleation plane and precise identification of the prostatic capsule. These conditions permit total resection of the prostatic adenoma and coagulation of small penetrating vessels, thereby reducing the laser emission time. Most of the complications in this series were encountered during morcellation, which in some cases was performed under poor vision because of venous bleeding due to surgical perforation of the capsule during enucleation. Conclusions Based on this analysis, we concluded that it is feasible for laser-naive urologists with endoscopic experience to learn to perform ThuLEP without tutoring. Those statements still require further validation in larger multicentric study cohort by several surgeon. The main novelty during the learning process was the use of a simulator that faithfully reproduced all of the surgical steps in prostates of various shapes and volumes.
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Affiliation(s)
- Giovanni Saredi
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Giacomo Maria Pirola
- Department of Urology, University of Modena e Reggio Emilia, viale Borri, 57, 21100, Varese, Modena, Italy.
| | - Andrea Pacchetti
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | | | - Giacomo Borroni
- Department of Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
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16
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Brazzelli V, Rivetti N, Badulli C, Carugno A, Cananzi R, De Silvestri A, Martinetti M, Borroni G. Mycosis fungoides: association of KIR ligands and HLA-DQB1*05 with bad prognosis of the disease. J Eur Acad Dermatol Venereol 2015; 30:266-9. [DOI: 10.1111/jdv.13083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/27/2015] [Indexed: 11/27/2022]
Affiliation(s)
- V. Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - N. Rivetti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - C. Badulli
- Immunogenetic Laboratory; Immunohematology Service and Trasfusional Medicine; Pavia Italy
| | - A. Carugno
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - R. Cananzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - A. De Silvestri
- Biometry and Statistics; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - M. Martinetti
- Immunogenetic Laboratory; Immunohematology Service and Trasfusional Medicine; Pavia Italy
| | - G. Borroni
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
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17
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Borroni G, Grassi S, Carugno A. Vasculitides with cutaneous expression in children: clinico-pathological correlations. GIORN ITAL DERMAT V 2015; 150:51-71. [PMID: 25516220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The most recent pediatric vasculitis classifications (EULAR/PRINTO/PRES) have proposed the use of an integration of clinical signs and symptoms, laboratory data, imaging and pathologic data. Pediatric vasculitis represent a peculiar clinical-diagnostic model, compared to the corresponding adult pathology chapter, and in particular, dermatopathologic aspects of these diseases identify more specific issues, made contingent by crucial variables such as duration of vasculitis lesion, site of the biopsy, proper biopsy depth, and possibility to correlate histopathological findings with immunopathological results. Possible additional diagnostic difficulties may arise from the fact that, in children, the same systemic disease, such as lupus erythematosus, may present with different clinical manifestations, with histopathological features of a precise type of vasculitis specific for that type of clinical manifestation. Examples are provided by hypocomplementemic urticarial vasculitis, cryoglobulinemic purpura, lymphocytic vasculitis of livedoid lesions. This paper describes the cutaneous histopathological findings of some vasculitis related pediatric diseases, be they pertaining to a systemic vasculitis with corresponding cutaneous vasculitis, to a systemic vasculitis with sporadic cutaneous vasculitic involvement, and to a systemic vasculitis without cutaneous vasculitic involvement. Type and level of histopathological vasculitic involvement, caliber of the vessel, type of vasculitis associated infiltrate, are likewise reliable integration in the complex diagnostic path of vasculitis in childhood. On the basis of these criteria dermatopathologists should be confident in identifying the type of the vasculitis and relate them to a specific pediatric disease.
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Affiliation(s)
- G Borroni
- Department of Clinical-Surgical Diagnostic and Pediatric Science, Unit of Dermatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy -
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18
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Vassallo C, Derlino F, Croci GA, Brazzelli V, Borroni G. Chronic localized leukocytoclastic vasculitis: clinicopathological spectrum of granuloma faciale with and without extrafacial and mucosal involvement. GIORN ITAL DERMAT V 2015; 150:87-94. [PMID: 25592670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Granuloma faciale (GF) is a rare cutaneous condition of unknown origin, that usually presents as one or more brown-purple papules, plaques and/or nodules, localized mostly on the face, although extrafacial lesions can also occur. Eosinophilic angiocentric fibrosis (EAF) is regarded as the mucosal counterpart of GF. Histologically, it has been described as a persistent leukocytoclastic vasculitis, with a dense polymorphous inflammatory infiltrate in the superficial and mid dermis, typically sparing the subpapillary dermis, the so called grenz zone. The presence of eosinophils is considered a characteristic feature of the disease. All the cases of GF seen at the Dermatology Unit from 2002 to 2013 were considered and reviewed, both clinically and histopathologically. Only cases with consistent clinical findings of GF, and accurate patient's history were considered. Ten cases of GF were reviewed for both histological specificity and clinico-pathological correlation. Two patients presented extrafacial lesions. One patient had involvement of nasal mucosa. Two patients suffered from associated rheumatological diseases. The most frequent histopathologic features were the presence of a grenz zone and eosinophils in the infiltrate, but also adnexal involvement was often present; vascular changes were constant, yet leukocytoclastic vasculitis could be recorded only in four cases. Fibrosis or sclerosis were always absent. Clinical pictures of the patients treated demonstrated a complete remission of the lesions, without scarring. However, a complete enduring healing was observed only in two patients, and relapse or incomplete remission of the disease was the rule. In conclusion a review of clinicopathological findings of ten patients affected by GF was made and new details of the disease presented.
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Affiliation(s)
- C Vassallo
- Dermatology Unit, Department of Medical, Surgical Diagnostic and Pediatric Science, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy -
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Borroni G, Tomasini C, Berti E. To classify or to discern? That's the problem. GIORN ITAL DERMAT V 2015; 150:27-28. [PMID: 25686286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- G Borroni
- Department of Clinical-Surgical Diagnostic and Pediatric Sciences, Dermatology Section, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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20
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Vassallo C, Pezzini C, Carugno A, Derlino F, Croci G, Paulli M, Borroni G. Cutaneous blastic plasmacytoid dendritic cell neoplasm: successful palliative treatment with oral prednisone in an elderly patient. Br J Dermatol 2014; 172:298-300. [DOI: 10.1111/bjd.13232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C. Vassallo
- Department of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Viale C. Golgi, 19 27100 Pavia Italy
| | - C. Pezzini
- Department of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Viale C. Golgi, 19 27100 Pavia Italy
| | - A. Carugno
- Department of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Viale C. Golgi, 19 27100 Pavia Italy
| | - F. Derlino
- Department of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Viale C. Golgi, 19 27100 Pavia Italy
| | - G. Croci
- Pathology Section; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Viale C. Golgi, 19 27100 Pavia Italy
| | - M. Paulli
- Pathology Section; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Viale C. Golgi, 19 27100 Pavia Italy
| | - G. Borroni
- Department of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Viale C. Golgi, 19 27100 Pavia Italy
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21
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Scalone L, Cortesi P, Mantovani L, Belisari A, Ayala F, Fortina A, Bonamonte D, Borroni G, Cannavò S, Guarneri F, Cristaudo A, De Pità O, Gallo R, Girolomoni G, Gola M, Lisi P, Pigatto P, Satta R, Giannetti A. Clinical epidemiology of hand eczema in patients accessing dermatological reference centres: results from Italy. Br J Dermatol 2014; 172:187-95. [DOI: 10.1111/bjd.13220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Scalone
- Research Centre on Public Health (CESP); University of Milan-Bicocca; Villa Serena Via Pergolesi 33 I-20052 Monza Italy
- CHARTA Foundation; Milan Italy
| | - P.A. Cortesi
- Research Centre on Public Health (CESP); University of Milan-Bicocca; Villa Serena Via Pergolesi 33 I-20052 Monza Italy
- CHARTA Foundation; Milan Italy
| | - L.G. Mantovani
- CHARTA Foundation; Milan Italy
- Faculty of Pharmacy; University of Naples Federico II; Naples Italy
| | | | - F. Ayala
- Department of Dermatology; University of Naples Federico II; Naples Italy
| | - A.B. Fortina
- Pediatric Dermatology Unit; Department of Medicine; University of Padova; Padova Italy
| | - D. Bonamonte
- Department of Biomedical Science and Human Oncology; Unit of Dermatology; University of Bari ‘Aldo Moro’; Bari Italy
| | - G. Borroni
- Clinical-Surgical, Diagnostic and Pediatric Science; Dermatology Unit; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - S.P. Cannavò
- Department of Clinical and Experimental Medicine-Unit of Dermatology; University of Messina; Messina Italy
| | - F. Guarneri
- Department of Clinical and Experimental Medicine-Unit of Dermatology; University of Messina; Messina Italy
| | - A. Cristaudo
- Department of Allergological and Occupational Dermatology; San Gallicano Dermatologic Institute, IRCCS; Rome Italy
| | - O. De Pità
- Laboratory of Immunology; Istituto Dermopatico dell'Immacolata (IDI)-IRCCS; Rome Italy
| | - R. Gallo
- Section of Dermatology; DISSAL - Department of Health Sciences; University of Genoa; Genoa Italy
| | - G. Girolomoni
- Department of Medicine; Section of Dermatology and Venereology; University of Verona; Verona Italy
| | - M. Gola
- Allergological and Occupational Dermatology Unit; Department of Critical Care Medicine and Surgery; University of Florence; Florence Italy
| | - P. Lisi
- Department of Medical and Surgical Specialities and Public Health; Section of Clinical, Allergological and Venereological Dermatology; University of Perugia; Perugia Italy
| | - P.D. Pigatto
- Department of Biomedical Science for Health IRCCS Galeazzi Hospital; University of Milan; Milan Italy
| | - R. Satta
- Institute of Dermatology; University of Sassari; Sassari Italy
| | - A. Giannetti
- Division of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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22
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Vassallo C, Derlino F, Brazzelli V, D'Ospina RD, Borroni G. Acute generalized exanthematous pustulosis: report of five cases and systematic review of clinical and histopathological findings. ACTA ACUST UNITED AC 2014. [PMID: 24819755 DOI: 10.4274/turkderm.34022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare, drug-related pustular eruption usually starting from folds with edema and erythema and with subsequent spreading. Clinically AGEP is characterized by the sudden appearance of dozen of sterile, non follicular, small pustules on erythematous and edematous skin. Mild non erosive mucosal involvement, mostly oral, may sometimes occur. Fever, neutrophilia and peripheral blood eosinophilia (in a third of patients) are present. Other skin signs such as facial edema, purpura, target-like lesions and blisters have been described but are not typical for AGEP. Diagnostic criteria for AGEP were established by an international committee of experts, the European Study of Severe Cutaneous Adverse Reactions (EuroSCAR). The most relevant histopathological feature is represented by the detection of non-follicular subcorneal and/or intracorneal spongiform pustules that are usually large, contiguous and tend to coalesce. After elimination of the causative drug, pustules usually spontaneously disappear in a few days with desquamation and the reaction fully resolves within 15 days. Internal organs are not usually involved and no systemic treatment is required. Withdrawal of the culprit drug is mandatory. Although AGEP is a self-limiting disease with a favourable prognosis, secondary infections are a not infrequent complication in patients in poor general medical conditions. The reported mortality is about 5%. The most severe cases are associated with drug rechallenge.
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Affiliation(s)
- C Vassallo
- Dermatology Unit, Department of Clinical‑Surgical Diagnostic and Pediatric Sciences, University of Pavia Policlinico San Matteo IRCCS Foundation, Pavia, Italy -
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23
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Vassallo C, Derlino F, Brazzelli V, D'Ospina RD, Borroni G. Acute generalized exanthematous pustulosis: report of five cases and systematic review of clinical and histopathological findings. GIORN ITAL DERMAT V 2014; 149:281-90. [PMID: 24819755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare, drug-related pustular eruption usually starting from folds with edema and erythema and with subsequent spreading. Clinically AGEP is characterized by the sudden appearance of dozen of sterile, non follicular, small pustules on erythematous and edematous skin. Mild non erosive mucosal involvement, mostly oral, may sometimes occur. Fever, neutrophilia and peripheral blood eosinophilia (in a third of patients) are present. Other skin signs such as facial edema, purpura, target-like lesions and blisters have been described but are not typical for AGEP. Diagnostic criteria for AGEP were established by an international committee of experts, the European Study of Severe Cutaneous Adverse Reactions (EuroSCAR). The most relevant histopathological feature is represented by the detection of non-follicular subcorneal and/or intracorneal spongiform pustules that are usually large, contiguous and tend to coalesce. After elimination of the causative drug, pustules usually spontaneously disappear in a few days with desquamation and the reaction fully resolves within 15 days. Internal organs are not usually involved and no systemic treatment is required. Withdrawal of the culprit drug is mandatory. Although AGEP is a self-limiting disease with a favourable prognosis, secondary infections are a not infrequent complication in patients in poor general medical conditions. The reported mortality is about 5%. The most severe cases are associated with drug rechallenge.
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Affiliation(s)
- C Vassallo
- Dermatology Unit, Department of Clinical‑Surgical Diagnostic and Pediatric Sciences, University of Pavia Policlinico San Matteo IRCCS Foundation, Pavia, Italy -
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24
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Borroni G, Torti S, Pezzini C, Vassallo C, Rosso R, D'Ospina RM, Tomasini C, Brazzelli V. Histopathologic spectrum of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): a diagnosis that needs clinico-pathological correlation. GIORN ITAL DERMAT V 2014; 149:291-300. [PMID: 24819756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is characterized by an heterogeneous group of severe dermatologic manifestations and systemic involvement, due to several groups of medicaments. A series of 9 consecutive cases, observed from 2008 to 2013 in the Department of Dermatology, University of Pavia, is reported, all satisfying the clinical, hematological and systemic diagnostic criteria of DRESS. Clinically, 4 out of 9 patients had an urticarial and papular eruption, 2 an erythema-multiforme-like (EM-like) pattern, 2 erythroderma and 1 had an erythematous and macular reaction. Aim of the study was to describe the histopathologic features of DRESS and to trace a possible correlation between the four clinical recognized types of the syndrome and the histopathological patterns. Predominantly, a superficial perivascular lymphocytic infiltrate, extravasation of erythrocytes, and focal interface changes characterized DRESS cases. Less frequently, histopathology revealed the presence of necrotic keratinocytes; surprisingly, only in 2 cases the presence of rare dermal eosinophils was detected, even if all the patients had significant peripheral eosinophilia. A histopathological diagnosis of DRESS seems per se, according to our data, not feasible, since the main histopathological changes (interface changes, superficial perivascular dermatitis, focal spongiosis, lichenoid infiltrate, rare presence of necrotic keratinocytes) can be interpreted generically as a drug induced dermatitis. The above mentioned histopathological changes, however, when associated with clinical information on cutaneous and systemic involvement of the patient, allow the pathologist or the dermatopathologist to make a diagnosis of DRESS with a reliable margin of certainty.
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Affiliation(s)
- G Borroni
- Department of Clinical‑Surgical, Diagnostic and Pediatric Sciences Dermatology Section, University of Pavia Foundation IRCCS Policlinico San Matteo, Pavia, Italy -
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Brazzelli V, Grassi S, Savasta S, Ruffinazzi G, Carugno A, Barbaccia V, Marseglia GL, Borroni G. Pompholyx of the hands after intravenous immunoglobulin therapy for clinically isolated syndrome: a paediatric case. Int J Immunopathol Pharmacol 2014; 27:127-30. [PMID: 24674688 DOI: 10.1177/039463201402700117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pompholyx is a common eruption of small vesicles on the palms, soles, and/or lateral aspects of the fingers. It has a multifactorial etiology, including genetic determinants, allergy to metals, and id reaction; rarely it is a drug-related side effect. We report a paediatric case of pompholyx of the hands related to the intravenous immunoglobulin (IVIG) therapy for Clinically Isolated Syndrome (CIS). A 10-year-old boy, received an IVIG therapy (Venital, Kedrion Spa, Italy) at a dose of 400 mg/kg daily for five days. The fifth day of IVIG infusion, a symmetrical vesicular eruption appeared on the palms of the hands and on lateral aspects of the fingers. The lesions improved with application of topical steroids in few days. The mechanism of induction of pompholyx by IVIG therapy is unknown. A review of the Literature suggests the hypothesis that dyshidrotic eczematous reactions may be related not only to the type of IVIG, to the dose and the rates of infusion, but also to an allergic response to excipients and preservatives contained in the drug, probably elicited by an underlying neurological disease in some cases.
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Affiliation(s)
- V Brazzelli
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - S Grassi
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - S Savasta
- Department of Paediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Ruffinazzi
- Department of Paediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - A Carugno
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - V Barbaccia
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G L Marseglia
- Department of Paediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Borroni
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Tomasini C, Derlino F, Quaglino P, Caproni M, Borroni G. From erythema multiforme to toxic epidermal necrolysis. Same spectrum or different diseases? GIORN ITAL DERMAT V 2014; 149:243-261. [PMID: 24819646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Erythema multiforme (EM), Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute bullous disorders associated to different prognosis, mainly due to infections and drugs. More in particular EM in more than 90% is caused by infections (especially Herpes virus infection), while, on the other hand SJS and TEN are referable in more than 95% of cases to drugs. Distinction among these three forms is often controversal and still debated. An attempt to distinguish these forms has been possible mainly according to anamnesis, clinical presentation (morphology, involved sites, extension of lesions) and pathogenetic mechanisms, being on the contrary more difficult from an histopathological point of view. Nowadays a clear diagnosis and a distinction from other life-threatening diseases is possible with the integration of all the mentioned aspects. Moreover, this recognition should be as early as possible in order to perform a prognostic evaluation of the case and to start supportive cares and therapies as soon as possible.
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Affiliation(s)
- C Tomasini
- Dermatopathology Section, Department of Medical Sciences University of Turin, Turin, Italy -
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Borroni G, Tomasini C. Why a monograph on cutaneous drug-induced reactions seen in histopathological perspective. GIORN ITAL DERMAT V 2014; 149:205. [PMID: 24819641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- G Borroni
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Dermatology Section, University of PaviaFondazione IRCCS Policlinico San Matteo, Pavia, Italy -
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Borroni G, Torti S, D'Ospina RM, Pezzini C. Drug-induced panniculitides. GIORN ITAL DERMAT V 2014; 149:263-270. [PMID: 24819647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A substantial number of all panniculitides fails to recognize a specific etiology, and that is true also for a relatively frequent type of panniculitis, such as erythema nodosum (EN). Between the recognized causative factors of panniculitides, infectious, physical agents, autoimmune mechanisms and neoplastic disorders are well known. On the contrary, the role of drugs as inducers of panniculitides is marginally considered, and their report limited to anecdotal observations, often without due histopathological support. Since the clinical and histopathological features of drug-induced panniculitides are indistinguishable from those caused by other agents, the causative relationship may be demonstrated by the history of previous drug intake and by clinical improvement after drug discontinuation. We reviewed the currently reported descriptions of drug-induced panniculitis, including a few exemplificative original observations. EN results as the most frequently reported drug-induced panniculitis. Among the causative drugs of EN a variety of medications, with disparate, or even opposite, mechanisms of action are reported, thus limiting the understanding of the pathogenesis. Common causative drugs include oral contraceptives, nonsteroidal anti-inflammatory drugs, antiobiotics and leukotriene-modifying agents. Unfortunately, in several cases, the diagnosis of drug-induced EN is done on clinical findings alone. In those cases, the lack of histopathological support does not allow to define a precise clinicopathological correlation on etiologic grounds. Drug-induced lobular and mixed panniculitides, including eosinophilic panniculitis, are even more rarely described. Reported causative agents are glatiramer acetate, interferon beta and heparin (at sites of injections), and systemic steroids, tyrosine kinase inhibitors and BRAF with subcutaneous fat involvement at distance. In view of the recent introduction of new classes of drugs, attention should be paid to disclose their possible etiologic role in inducing among other side effects, also panniculitides.
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Affiliation(s)
- G Borroni
- Department of Clinical‑Surgical Diagnostic and Pediatric Sciences Dermatology Section, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy -
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Brazzelli V, Rivetti N, Badulli C, Carugno A, Grasso V, De Silvestri A, Martinetti M, Borroni G. Immunogenetic factors in mycosis fungoides: can the HLA system influence the susceptibility and prognosis of the disease? Long-term follow-up study of 46 patients. J Eur Acad Dermatol Venereol 2014; 28:1732-7. [DOI: 10.1111/jdv.12391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/10/2014] [Indexed: 12/20/2022]
Affiliation(s)
- V. Brazzelli
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - N. Rivetti
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - C. Badulli
- Immunohematology Service and Trasfusional Medicine; Immunogenetic Laboratory; Pavia Italy
| | - A. Carugno
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - V. Grasso
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - A. De Silvestri
- Biometry and Statistics; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - M. Martinetti
- Immunohematology Service and Trasfusional Medicine; Immunogenetic Laboratory; Pavia Italy
| | - G. Borroni
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
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Brazzelli V, Barruscotti S, Calafiore L, Zecca M, Borroni G. Bleomycin-induced flagellate dermatitis: report of four paediatric cases. J Eur Acad Dermatol Venereol 2013; 28:670-1. [DOI: 10.1111/jdv.12245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V. Brazzelli
- Institute of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - S. Barruscotti
- Institute of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - L. Calafiore
- Pediatric Hematology-Oncology Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - M. Zecca
- Pediatric Hematology-Oncology Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - G. Borroni
- Institute of Dermatology; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
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Lesch O, Skala K, Addolorato G, Caputo F, Ceccanti M, Djurkowski M, Filipecka E, Habrat B, Horodnicki J, Pini LA, Platz W, Spazzapan B, Walter H, Caputo F, Skala K, Walter H, Ceccanti M, Djurkowski M, Filipecka E, Florkowski A, Gerra G, Holzbach R, Horodnicki J, Platz W, Spazzapan B, Zblowska H, Bernardi M, Cacciaglia R, Vivet P, Lesch OM, Addolorato G, Vivet P, Pross N, Denot C, Patat A, Nava F, Bravin S, Borroni G, Bosticco E, Affini GF, Gasparini GL, Manzato E, Thoux M, Torriani M, Richini M, Lucchini A. SAT2 * SODIUM OXYBATE, A BREAKTHROUGH TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME AND MAINTENANCE OF ALCOHOL ABSTINENCE (D&A). Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Borroni G, Tomasini CF. The "raison d'être" of a monograph on panniculitides. GIORN ITAL DERMAT V 2013; 148:313-314. [PMID: 23900154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- G Borroni
- Department of Clinical and Surgical Diagnostic and Pediatric Sciences, Dermatology Clinic, University of Pavia, IRCCS Fondazione Policlinico "San Matteo", Pavia, Italy
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Grassi S, Rosso R, Tomasini C, Pezzini C, Merlino M, Borroni G. Post-surgical lipophagic panniculitis: a specific model of traumatic panniculitis and new histopathological findings. GIORN ITAL DERMAT V 2013; 148:435-441. [PMID: 23900165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aim of this work was to define the histopathological features of post-surgical panniculitis. Dermal and hypodermal changes will be analyzed in detail, to understand the cascade of events that characterize the tissue response to surgical trauma. Cutaneous re-excision specimens of cases of basal cell carcinoma, squamous cell carcinoma, and melanoma consecutively seen from January 1, 2011 to June 30, 2011 at the Department of Dermatology, University of Pavia, were included in this study. Only the cases in which the first surgical procedure included the subcutaneous fat, were considered. In addition, the time elapsed from the first surgical procedure and the re-excision had to be included in a period of time from one to three months. All the specimens were stained with hematoxylin and eosin. Thirty cutaneous re-excision specimens were studied. Histopathologic examination revealed changes of epidermis, ranging from slight atrophy to moderate hyperplasia. In two cases focal ulceration was seen, with transfollicular elimination of foreign body material. The main dermal changes observed were the: 1) scar with well defined vertical orientation along the dermal suture line; 2) rounded cicatricial areas with radial branching septa of scarring tissue; 3) foreign body granuloma formation; 4) alignment of hystiocytes at the dermo-hypodermal border; 5) traumatic neuromas. The subcutaneous fat changes included: 1) lobular panniculitis with consistent presence of foam cells; 2) striking anisocytosis with pseudocystic degeneration and necrosis of adipocytes; 3) eritrocyte extravasation, mainly at the dermo-hypodermal border; 4) deep seated phlebitis. Post-surgical panniculitis is a lobular foam cell panniculitis characterized by simultaneous dermal and hypodermal changes, expression of the multi-faceted tissue response to a surgical trauma. This type of peculiar lipophagic response puts post-surgical panniculitis into the wider chapter of lipophage tissue response seen in atherosclerosis, glomerulosclerosis and some infectious models such as Mycobacterium tuberculosis and Chlamydia pneumoniae infections. Furthermore it may be seen as a reliable and convenient model for laboratory investigation on foam cell tissue response.
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Affiliation(s)
- S Grassi
- Department of Clinical and Surgical Diagnostic and Pediatric Sciences, Dermatology Clinic University of Pavia IRCCS Fondazione Policlinico San Matteo, Pavia, Italy -
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Borroni G, Giorgini C, Tomasini C, Brazzelli V. How to make a specific diagnosis of panniculitis on clinical grounds alone: an integrated pathway of general criteria and specific findings. GIORN ITAL DERMAT V 2013; 148:325-333. [PMID: 23900156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A clinical approach to the vexing problem of diagnosis of panniculitis is traced in this paper, in order to obtain from the clinical findings, history and laboratory data of the patient useful, detailed and precise information, essential to address dermatologists to a specific clinical diagnosis of panniculitis. This approach is created in the same way as when a dermatologist faces any other dermatological disease, be it inflammatory or neoplastic. A common behavior in case of panniculitis is in fact just to take an adequate biopsy and wait for the pathologist report. This is indeed a limitation both for the dermatologist and above all for the pathologist, who is in tremendous need for detailed clinical information before signing his report. The most common types of panniculitides, taking into account their main clinical diagnostic criteria, will be considered. In particular, Erythema Nodosum, Panniculitides in Sarcoidosis, Pancreatic Panniculitis, Lupus Panniculitis, Erythema Induratum/Nodular Vasculitis and Weber-Christian Panniculitis/Rothman-Makai Pannicultis will be analyzed. Every chapter will consider general criteria (epidemiology, age and gender, distribution of the lesions, laboratory findings) and specific findings (characteristics of the lesions, i.e. redness, pain, tenderness, evolution, ulceration, sites of involvement) as well as comorbidities and systemic signs and symptoms. Detailed analysis of the general criteria integrated with the specific findings will allow the clinicians to reach a clinical diagnosis with a high degree of confidence.
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Affiliation(s)
- G Borroni
- Department of Clinical and Surgical Diagnostic and Pediatric Sciences. Dermatology Clinic University of Pavia and IRCCS Policlinico San Matteo Pavia, Italy -
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Tomasini C, Lentini F, Borroni G. The role of skin biopsy in diagnosis of panniculitides. GIORN ITAL DERMAT V 2013; 148:335-349. [PMID: 23900157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Several factors hamper the clinical and histologic diagnosis of panniculitis. Clinically the patients tend to present with erythematous subcutaneous nodules with quite a monotonous appearance, without additional symptoms. Histopathologically, as the subcutaneous fat responds to a variety of insults in a limited number of forms, there are sometimes subtle pathologic differences among the conditions. Although the biopsy plays a critical role in the diagnostic process of a panniculitis, a series of prerequisites must be met in order to obtain as much information as possible from this procedure. If the biopsy is inadequate, i.e., does not include sufficient subcutaneous fat or the site of sampling site/biopsy timing is wrong, histopathologic assessment is limited and the correct diagnosis may be delayed and further sampling may be required. This article introduces the reader to the field of panniculitides under the histopathologic perspective through a brief description of the normal histology of subcutaneous fat. I also includes the definition of the types of fat necrosis, role of biopsy of panniculitis and its rules and pitfalls, up to a microscopic approach of a slide.
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Affiliation(s)
- C Tomasini
- Dermatopathology Section, Azienda Ospedaliera Città della Salutee della Scienza, Turin, Italy -
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Brazzelli V, Grasso V, Borroni G. Imatinib, dasatinib and nilotinib: a review of adverse cutaneous reactions with emphasis on our clinical experience. J Eur Acad Dermatol Venereol 2013; 27:1471-80. [PMID: 23611501 DOI: 10.1111/jdv.12172] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/02/2013] [Indexed: 11/27/2022]
Abstract
In the last years, several tyrosine kinase inhibitors (TKIs) have been developed and approved for human cancer treatment. Imatinib mesylate was the first of this novel family of drugs that target cancer-specific molecules and signalling pathways. The appearance of imatinib resistances led to the introduction of second-generation TKIs with higher potency and selectivity, such as dasatinib and nilotinib. However, the range of activity of these agents is not simply directed at tumour cells. Patients and their clinicians are indeed frequently confronted with the cutaneous side-effects associated with the employ of these drugs, which represent the most common non-hematological adverse reactions. For this reason, a systematic dermatological survey of patients receiving these therapies is highly important, and an early and appropriate dermatological treatment is required. In this review, we analyse the clinical and pathological characteristics of the most commonly reported adverse skin events associated with first- and second-generation tyrosine kinase inhibitors, with a particular emphasis on our clinical experience.
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Affiliation(s)
- V Brazzelli
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Institute of Dermatology, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy
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Borroni G, Cazzaniga M, Andreoletti M, Ceriani R, Guerzoni P, Omazzi B, Pich MGL, Prada A, Spinzi G, Terreni N, Salerno F. Low glomerular filtration rate is a risk factor for ribavirin-associated anaemia in old patients with chronic hepatitis C. J Viral Hepat 2013; 20:e90-5. [PMID: 23490395 DOI: 10.1111/jvh.12015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/01/2012] [Indexed: 01/28/2023]
Abstract
Elderly patients with chronic hepatitis C have a reduced responsiveness to antiviral therapy with Peg-interferon and ribavirin. The dose reduction or the discontinuation of ribavirin due to the occurrence of anaemia is one of the most important causes for the low sustained viral response observed in older patients. We aimed to evaluate the relationship between baseline renal function and the early onset of ribavirin-associated anaemia in older (≥60 years) patients. Using data from 348 patients with chronic hepatitis C consecutively treated with peg-interferon plus ribavirin, we investigated which factors were associated with the occurrence of anaemia in elderly patients (≥60 years). Ribavirin-induced anaemia occurred in 40.5% of patients. Older patients showed a rate of anaemia significantly higher than younger patients (51.5% vs 36.3%; P = 0.009). Consequently, the rate of ribavirin dose reduction or discontinuation due to anaemia was 35.1% in older patients and 23.5% in younger patients (P = 0.029). A significantly higher proportion of older patients had a low baseline glomerular filtration rate (GFR) compared with younger patients (56.7% vs 27.1%; P < 0.001). At the multivariate regression analysis, low baseline GFR (<70 mL/min) was associated with an increased risk of ribavirin-associated anaemia only in the older patients (OR: 3.526; 95% CI: 1.385-8.979; P = 0.008). In this subset, baseline GFR was significantly correlated with both absolute (r = -0.320; P < 0.001) and relative (r = -0.324; P < 0.001) haemoglobin decrease within the first 8 weeks of treatment. In patients aged >60 years, a low pre-treatment GFR was strongly associated with the risk to develop ribavirin-related anaemia with consequent reduction in ribavirin doses.
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Affiliation(s)
- G Borroni
- Unità Organizzativa Alcoldipendenze, ASL Provincia di Milano 1, Abbiategrasso, Milan, Milan, Italy.
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Borroni G, Brazzelli V, Fornara L, Rosso R, Paulli M, Tinelli C, Ciocca O. Clinical, Pathological and Immunohistochemical Effects of Arsenical-Ferruginous SPA Waters on Mild-To-Moderate Psoriatic Lesions: A Randomized Placebo-Controlled Study. Int J Immunopathol Pharmacol 2013; 26:495-501. [DOI: 10.1177/039463201302600223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Thermalism and spa treatments are traditionally considered effective in a number of dermatologic inflammatory conditions, yet there is scarce evidence about spring water effectiveness on psoriasis in a daily setting. We enrolled 34 patients with mild-to-moderate psoriasis in a double-blind, randomized, placebo-contralaterally-controlled trial, to evaluate Levico and Vetriolo arsenical-ferruginous water effectiveness on psoriatic lesions by daily 20-minute wet packing for 12 consecutive days. Clinical, histopathologic and immunohistochemical parameters were considered. A statistically significant difference between spa water-treated lesions and placebo-treated lesions in the same patients was demonstrated for histopathologic and immunohistochemical parameters. Since iron ions have an antiproliferative effect on epithelia, and magnesium ions have an anti-inflammatory effect, Levico and Vetriolo water effectiveness on psoriasis could be addressed to their content of these ions.
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Affiliation(s)
- G. Borroni
- Dermatology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - V. Brazzelli
- Dermatology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - L. Fornara
- Dermatology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - R. Rosso
- Anatomic Pathology Section, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - M. Paulli
- Anatomic Pathology Section, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - C. Tinelli
- Scientific Direction, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - O. Ciocca
- Dermatology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
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Borroni G, Biagi F, Ciocca O, Vassallo C, Carugno A, Cananzi R, Campanella J, Bianchi P, Brazzelli V, Corazza G. IgA anti-epidermal transglutaminase autoantibodies: a sensible and sensitive marker for diagnosis of dermatitis herpetiformis in adult patients. J Eur Acad Dermatol Venereol 2012; 27:836-41. [DOI: 10.1111/j.1468-3083.2012.04586.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Gregorini M, Castello M, Rampino T, Esposito P, Rosso R, Borroni G, Dal Canton A. Erythema nodosum in kidney transplant recipient: a rare complication of pneumonia treatment. Transpl Infect Dis 2012; 14:72-4. [PMID: 21466642 DOI: 10.1111/j.1399-3062.2011.00635.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Erythema nodosum (EN) is a cutaneous inflammatory reaction, usually reported in young women, but it is rarely observed among transplant patients. Localization in the lower extremities is typical, mostly involving the anterior surfaces of the legs. Several viral, bacterial, mycotic, and non-infectious etiologies, such as autommune disorders, drugs, inflammatory bowel diseases, sarcoidosis, pregnancy, and malignancies, have been found. We describe the case of a young woman kidney transplant recipient developing bilateral, erythematous, warm nodules localized on the anterior surface of her legs after antibiotic treatment for pneumonia with levofloxacin. Her immunosuppression was sirolimus and mycophenolate mofetil. EN was diagnosed by skin biopsy; microscopic examination showed septal panniculitis with granulomas. As a complete remission of the lesions was obtained in our patient after interruption of levofloxacin therapy, we suspect that levofloxacin was involved in the pathogenesis of EN. In fact, the management of EN is based on the treatment of underlying or associated conditions.
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Affiliation(s)
- M Gregorini
- Department of Nephrology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
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Ciprandi G, De Amici M, Legoratto S, Giunta V, Vignini M, Borroni G. Serum IL-9 levels in patients with spontaneous urticaria: a preliminary study. J Investig Allergol Clin Immunol 2012; 22:232-234. [PMID: 22697022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- G Ciprandi
- IRCCS - Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
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Brazzelli V, Calcaterra V, Muzio F, Klersy C, Larizza D, Borroni G. Reduced sebum production in Turner syndrome: a study of twenty-two patients. Int J Immunopathol Pharmacol 2011; 24:789-92. [PMID: 21978710 DOI: 10.1177/039463201102400325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Turner's syndrome (TS) is a genetic disorder caused by numeric and/or structural abnormalities of the X chromosome. In a previous study it was observed that acne is less frequent in TS than in the general population. Since the onset of acne in pre-pubertal or pubertal age is related to sebum production, this study evaluates sebum secretion in TS patients, comparing the results with those of a control group of age-matched healthy female subjects. A total of 22 patients affected by TS (mean age 26.56±7.89 years) and a control group of 23 age-matched healthy females were studied. Sebum production was measured using a Sebumeter SM810. Mean sebum secretion in TS subjects was significantly lower than in the control group (81.35±66.44 UA vs 147.09±33.62 UA, p<0.001) and this significant difference was found in every facial zone. The reduction of sebum secretion may explain, using a simple and non-invasive method, the absence or the low incidence of acne in TS patients.
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Brazzelli V, Carugno A, Alborghetti A, Grasso V, Cananzi R, Fornara L, De Silvestri A, Borroni G. Prevalence, severity and clinical features of psoriasis in fingernails and toenails in adult patients: Italian experience. J Eur Acad Dermatol Venereol 2011; 26:1354-9. [DOI: 10.1111/j.1468-3083.2011.04289.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brazzelli V, Grasso V, Manna G, Barbaccia V, Merante S, Boveri E, Borroni G. Indolent systemic mastocytosis treated with narrow-band UVB phototherapy: study of five cases. J Eur Acad Dermatol Venereol 2011; 26:465-9. [PMID: 21564325 DOI: 10.1111/j.1468-3083.2011.04098.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mastocytoses represent a heterogeneous group of stem cell disorders marked by an abnormal hyperplasia and accumulation of mast cells in one or more tissues, including bone marrow, gastrointestinal tract, liver, spleen, lymph nodes and skin. Indolent systemic mastocytosis (ISM) is characterized by red-brownish and pruriginous maculopapular lesions, a bone marrow infiltration without functional impairment and an indolent clinical course with a good prognosis. In particular, the most common cutaneous symptoms are urticarial rash and mild-to-high pruritus. OBJECTIVES This study analyses the clinical outcome of patients affected by ISM with prevalent pruriginous cutaneous symptoms and a scarce response to anti-histamines treated using narrowband ultraviolet B (NB-UVB) phototherapy. METHODS Narrowband ultraviolet B phototherapy was administered in a UV-irradiation cabin equipped with fluorescent UVB lamps with a peak emission at 311-313 nm. The perception of pruritus severity was assessed using the Visual Analogue Scale (VAS) before starting the treatment and at each control. RESULTS A complete remission of the cutaneous lesions and pruritus was documented in all patients after a median of 40.3 UV treatments and a median cumulative dose of 51.4 J/cm(2), with a lasting remission over a 6-month follow-up. The median VAS score at the beginning of the treatment was 86.6 (SD=6.64), whereas it decreased to 6.66 (SD=3.75) after 3 months of therapy. CONCLUSIONS Our work provides evidence that NB-UVB phototherapy is useful for the treatment of the cutaneous symptoms and pruritus in ISM.
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Affiliation(s)
- V Brazzelli
- Department of Human and Hereditary Pathology, Institute of Dermatology, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
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Brazzelli V, Grasso V, Fornara L, Moggio E, Gamba G, Villani S, Borroni G. Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and correlation with disease severity. Int J Immunopathol Pharmacol 2010; 23:911-6. [PMID: 20943063 DOI: 10.1177/039463201002300327] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hyperhomocysteinaemia represents an independent risk factor for atherosclerotic cardiovascular disease, stroke, peripheral arterial occlusive disease and venous thrombosis. Psoriasis is a chronic inflammatory skin disease associated with increased atherothrombosis and cardiovascular risk profile. The aim of this study is to investigate homocysteine, folic acid and vitamin B12 levels in a cohort of psoriatic patients and its relationship with the severity of the disease. A retrospective observational study in 98 patients with chronic plaque psoriasis and 98 healthy controls was performed. Total plasma homocysteine level, folic acid, vitamin B12 and PASI index were assessed in every patient. Patients with psoriasis had plasma homocysteine levels higher than controls (57% of cases and 25% of controls; p<0.0001). Folic acid and vitamin B12 plasma levels were lower in psoriatic patients than in controls (p = NS), lower levels of vitamin B12 were found in patients with hyperhomocysteinaemia compared to patients with a normal value of homocysteine (p = 0.0009). The severity of psoriasis assessed according to PASI (19.51+/-16.26) did not directly correlate either with higher levels of homocysteine or with vitamin B12 and folic acid plasma levels. In conclusion, a significantly higher prevalence of hyperhomocysteinaemia was found in psoriatic patients compared to healthy controls. A significant correlation between hyperhomocysteinaemia and lower vitamin B12 levels, but not folic acid, was evidenced. On the contrary, our data do not correlate the high level of homocysteine with higher PASI scores or psoriasis type, suggesting that homocysteine level can be considered an independent risk factor in psoriatic patients.
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Affiliation(s)
- V Brazzelli
- Department of Human and Hereditary Pathology, Institute of Dermatology, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
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Vassallo C, Brazzelli V, Zecca M, Locatelli F, Alessandrino PE, Borroni G. Isomorphic cutaneous graft-versus-host disease reaction after ultraviolet exposure: clinical, histological and direct immunofluorescence studies of four allo-transplanted patients. J Eur Acad Dermatol Venereol 2009; 23:913-8. [PMID: 19586515 DOI: 10.1111/j.1468-3083.2009.03220.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute and chronic graft-versus-host disease (GVHD) continues to be a major limitation to successful haematopoietic stem cell transplantation. If experimental studies and clinical observations could partially elucidate the pathophysiology of acute GVHD, the biology of chronic GVHD is still much less well understood. OBJECTIVES The aim of this study is to describe a peculiar photoinduced rash which triggered acute and then chronic lesions of GVHD in four allogenic haematopoietic-transplanted patients and discuss the possible aetiology and treatment. PATIENTS/METHODS Four patients, two children and two adults affected by either mild or severe chronic GVHD, developed an erythematous rash on sun- or narrow-band ultraviolet B-exposed area, which triggered the onset of acute lesions of GVHD. Any of the patients presented neither a history of photosensitivity nor circulating autoantibodies nor urinary/fecal porphyrine. RESULTS The histopathologic findings were characterized by an interface dermatitis with sparse perivascular infiltrate of lymphocytes and scattered necrotic keratinocytes, especially in the upper part of epidermis. Direct immunofluorescence studies excluded lupus-like pattern, revealing nests of fluorescent bodies at the dermal-epidermal junction and in papillary dermis. CONCLUSIONS This peculiar isomorphic reaction of cutaneous GVHD after sun or narrow-band ultraviolet B exposures is described, and the possible mechanism involved is discussed. It may represent an interesting model of progression of chronic GVHD, starting with an acute stage and ending up with chronic clinical and histological findings, especially considering that there is no animal model that fully replicates all of the features of chronic GVHD in humans.
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Affiliation(s)
- C Vassallo
- Department of Dermatology, Fondazione IRCCS-Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Vassallo C, Brazzelli V, Borroni G. Cutaneous blisters as the presenting signs of recurrent thyroglossal duct cyst in a child. Clin Exp Dermatol 2009; 34:e457-8. [DOI: 10.1111/j.1365-2230.2009.03505.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brazzelli V, Grasso V, Muzio F, Moggio E, Zecca M, Locatelli F, Borroni G. Narrowband ultraviolet B phototherapy in the treatment of cutaneous graft-versus-host disease in oncohaematological paediatric patients. Br J Dermatol 2009; 162:404-9. [DOI: 10.1111/j.1365-2133.2009.09503.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brazzelli V, Muzio F, Antoninetti M, Villani S, Donadini F, Altomare A, Borroni G. The perilesional skin in vitiligo: a colorimetricin vivostudy of 25 patients. Photodermatology, Photoimmunology & Photomedicine 2008; 24:314-7. [DOI: 10.1111/j.1600-0781.2008.00383.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brazzelli V, Larizza D, Muzio F, Calcaterra V, Fornara L, Klersy C, Borroni G. Low frequency of acne vulgaris in adolescent girls and women with Turner’s syndrome: a clinical, genetic and hormonal study of 65 patients. Br J Dermatol 2008; 159:1209-11. [DOI: 10.1111/j.1365-2133.2008.08825.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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