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Complicanze nel trattamento scleroterapico delle malformazioni venose
No full textIntroduzione e obiettivi:
Le malformazioni venose (MV) rappresentano la più comune forma di malformazione vascolare che interessa il distretto cervico-facciale. La scleroterapia, in particolare con l’utilizzo di sostanze sclerosanti come etanolo e sodio tetradecilsolfato (STS), rappresenta una metodica di scelta nel trattamento delle MV per efficacia e sicurezza. Le caratteristiche ottimali di questa metodica portano spesso a sottostimare i potenziali – seppur rari – effetti avversi legati al trattamento. L’obiettivo di questo studio è di valutare retrospettivamente i rischi legati alla scleroterapia con STS su un’ampia casistica di pazienti.
Materiale e metodi:
Sono stati inclusi nello studio 21 pazienti consecutivi con MV localizzate nel distretto cervico-facciale, trattati con STS-scleroterapia presso il reparto di chirurgia maxillo-facciale dell’Ospedale San Paolo di Milano nel periodo compreso tra Settembre 2013 e Giugno 2014. 11 pazienti sono stati sottoposti a una singola seduta di scleroterapia; 10 a due sedute. 7 pazienti considerate le piccole dimensioni della MV sono stati trattati in anestesia locale senza guida fluoroscopia; 14 sono invece stati sottoposti a sclerotizzazione in anestesia generale sotto guida fluoroscopica. Per ogni paziente si sono valutati la comparsa di complicanze minori e maggiori e di algie, con follow-up medio di sei mesi.
Risultati:
Complicanze minori con regressione completa entro 3 settimane dalla procedura si sono evidenziate in una percentuale significativa di pazienti. Nello specifico il 38% dei pazienti ha riportato la formazione di ulcere cutanee, il 24% l’insorgenza di lesioni vescicolo-bollose, il 14% di emorragie, il 48% di deficit motori, il 38% di deficit sensitivi e il 48% di algie. In una paziente è stato riscontrata immediatamente dopo la procedura la paralisi di un ramo centrofaciale del VII nervo cranico, con risoluzione solo parziale nel follow up. In una paziente la presenza misconosciuta di un forame ovale pervio ha causato un deficit ischemico neurologico reversibile con disartria e dismetria temporanee su base embolica paradossa.
Conclusioni:
Il trattamento delle MV con il STS ha mostrato buona efficacia, elevata tollerabilità da parte dei pazienti e scarsa tossicità. Ciononostante i possibili effetti avversi della terapia devono essere ben noti al clinico, che deve garantire una pianificazione e gestione ottimale del paziente. In quest’ottica anche la somministrazione di un adeguato consenso informato al paziente è fondamentale, sia dal punto di vista etico che medico-legale
An observational study regarding the rate of growth in vertical and radial growth phase superficial spreading melanomas
Full text linkThe natural history of superficial spreading melanomas (SSMs) involves the progression from a radial growth phase (RGP) to a vertical growth phase (VGP). Currently, a patient’s history represents the only method to estimate the rate of tumor growth. The present study aimed to verify whether the estimated rate of growth (ROG) of SSMs with a RGP or VGP exhibited any differences, and to evaluate the possible implications for the most important prognostic determinants. ROG was quantified as the ratio between Breslow’s thickness in millimeters (mm) and the time of tumor growth in months, defined as the time between the date that the patient had first noticed the lesion in which melanoma subsequently developed and the date on which the patient first felt this lesion changed. A total of 105 patients (58 male and 47 female) were studied. Of these, 66 had VGP-SSMs, whilst 39 had RGP-only SSMs (RGP-SSMs). No significant differences in age and gender were observed between these groups. The mean Breslow’s thickness in patients with VGP-SSMs was significantly greater than in patients with RGP-SSMs (0.78±0.68 vs. 0.48±0.22 mm, P=0.0096). Similarly, the ROG was observed to be higher in VGP-SSM vs. RGP-SSM patients (0.13±0.16 vs. 0.065±0.09 mm/month, P=0.0244). In patients with VGP-SSMs, Breslow’s thickness and ROG were significantly higher for tumors with a mitotic rate of ≥1 mitosis/mm2 compared with those with <1 mitosis/mm2 (1.15±0.96 vs. 0.56±0.30 mm, P=0.0005; and 0.188±0.20 vs. 0.09±0.12 mm/month, P=0.0228, respectively). According to these results, two subsets of SSMs exist: The first is characterized by the presence of mitosis and a higher ROG, while the second exhibits a more indolent behavior and is characterized by an RGP only. Given the differences in the Breslow’s thickness and ROG, clinicians must be aware of the possible diagnostic delay in these subsets of melanoma that, differently from true nodular melanomas, generally fulfill the classical ABCD clinical criteria
Lichen sclero-atrofico bolloso extra-genitale
No full textLichen sclerosus et atrophicus (LSA) is a chronic inflammatory disorders of unknown cause, described first in 1887 by Hallopeau. Affected female patients clearly outnumber male patients and there is a typical bimodal onset in pre-puberal children and in post-menopausal women. In both sexes, there is a distinc predilection for anal-genital region. The 15-20% of cases of extra-genital involvement is associated with classical genital LSA; isolated bullous LSA is infrequent. We report the case of a 73-year-old woman with bullous extra-genital LSA, affected from years by vulvar LSA and oral mucosal lesions
Angles and geometric shapes, but not lines, in melanocytic lesions may be helpful in the clinical diagnosis of melanoma
No full textBackground: Geometric shapes have been suggested to be found in malignant melanomas. We have observed a number of melanomas presenting with linear and incomplete angulated figures. Objective: To verify the assumption that geometric shapes, a linear border and/or incomplete angulated figures may indicate a potential melanoma. Methods: Patients with surgically removed melanocytic lesions were admitted to the study. We evaluated the presence of a sharp linear demarcation, the presence of contiguous lines resulting in the formation of angle/s and the presence of complete geometric figure. We distinguished the obtained results into melanoma and benign melanocytic naevi. Results: A total of 471 melanomas and 1979 melanocytic naevi were collected. Linear borders, angles and geometric figures were observed in 42 melanomas and in 75 benign melanocytic naevi. Angles with incomplete geometric configuration were observed in 21 melanomas and in 37 benign naevi (21/471 vs. 37/1979, 4.24% vs. 1.87%; P < 0.0016); complete even if irregular geometrical figures in 12 melanomas and 17 naevi (12/471 vs. 17/1979, 2.54% vs. 0.85%; P < 0.005). The presence of line(s) did not significantly differed in the two considered groups. Conclusions: Melanocytic lesions with angulated shapes and complete geometrical configurations might indicate a suspect melanoma. Only sharp linear demarcation of the lesion do not seem to be significantly associated with melanoma suspicion
L'amore e i suoi enigmi nella Bibbia e nei Padri, Eros e agape. Forum teologico interdisciplinare
No full textMastocitosi cutanea papulosa congenita. Congenital papular cutaneous mastocytosis
No full textMastocytosis is defined as a heterogeneous group of dosorders characterized by accumulation of mastcells. Childhood mastocytosis is usually limited solely to the skin and resolves slowly over the first 1-2 decades of life. Systematic involvement in children is extremely rare. It is important to establish a correct diagnosis and therapeutic flow chart for these patients
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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