73 research outputs found
Adenocarcinoma vulvare metastatico: un caso diagnosticato tardivamente
No full textThe case of a woman aged 80 who had suffered from an "eczematous" , fixed and progressively extending plaque of the external genitalia is reported. After 1 year of inappropriate treatments (topical antimycotic agents and corticosteroids), the condition was properly, but lately, diagnosed as Paget's disease of the vulva. The staging was T3/N2/M1 (FIGO IVB), that is, too late for a timely definitive surgery. Histogenesis, biological basis, and treatment problems of extramammary Paget's disease are briefly discussed, along with the puzzling fact that this diagnosis is still unwarrantedly missed. The necessity to recur to anecdotal, empirical treatments for rare severe conditions is also underlined
ASO Author Reflections: Amid Anatomic Restrictions, Three-Dimensional Surgical Planning Eases En Bloc Resection of the Retro-Hepatic Vena Cava and the Caudate Lobe of the Liver
No full textThe use of Pimecrolimus cream 1% in the treatment of facial psoriasis.
No full textAim. To evaluate the efficacy of pimecrolimus cream 1% in patients with facial psoriasis. Methods. In this open study, 40 patients of both sexes (27 males and 13 females) aged between 18 and 75 years (mean age: 48.3 years) with psoriasis vulgaris affecting also the face (PASI ≤12) have been treated with pimecrolimus cream 1%. The drug has been applied to the facial lesions twice daily for 2 months. Results. Upon completion of treatment, the complete resolution of the lesions has been documented in 42.5% of cases (17 patients), and an improvement in all symptoms of erythema, desquamation and infiltration in 52.5% of cases (21 patients). Only 1 patient interrupted the treatment due to intolerance to the drug. Conclusions. In our study pimecrolimus cream 1% has shown a high level of efficacy and good tolerability in the majority of cases treated, revealing itself to be a valid therapeutic option in the treatment of facial psoriasis
Overtopping metrics and coastal safety: A case of study from the catalan coast
No full textDesign criteria for coastal defenses exposed to wave overtopping are usually assessed by mean overtopping discharges and maximum individual overtopping volumes. However, it is often difficult to give clear and precise limits of tolerable overtopping for all kinds of layouts. A few studies analyzed the relationship between wave overtopping flows and hazard levels for people on sea dikes, confirming that one single value of admissible mean discharge or individual overtopping volume is not a sufficient indicator of the hazard, but detailed characterization of flow velocities and depths is required. This work presents the results of an experimental campaign aiming at analyzing the validity of the safety limits and design criteria for overtopping discharge applied to an urbanized stretch of the Catalan coast, exposed to significant overtopping events every stormy season. The work compares different safety criteria for pedestrians. The results prove that the safety of pedestrians on a sea dike can be still guaranteed, even for overtopping volumes larger than 1,000 L/m. Sea storms characterized by deep-water wave height between 3.6 and 4.5 m lead to overtopping flow depth values larger than 1 m and flow velocities up to 20 m/s. However, pedestrian hazard is proved to be linked to the combination of overtopping flow velocity and flow depth rather than to single maximum values of one of these parameters. The use of stability curves to assess people's stability under overtopping waves is therefore advised.Environmental Fluid Mechanic
Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation
No full textBackground: Although behavioural treatment (biofeedback) successfully treats the pelvic floor abnormalities in patients with idiopathic constipation, many patients also normalise their impaired bowel frequency. We postulated that a response may be associated with altered cerebral outflow via extrinsic autonomic nerves to the gut. We investigated whether treatment changes extrinsic innervation, using mucosal laser Doppler flowmetry, whether autonomic changes are gut specific, and whether it changes gut transit.
Materials and methods: Forty nine patients (44 female, mean age 39 years) with idiopathic constipation were studied before and after biofeedback treatment (mean five sessions). Rectal mucosal blood flow was measured by laser Doppler flowmetry to assess direct extrinsic gut nerve autonomic activity. To assess general autonomic activity, RR (interval between successive R waves on the electrocardiogram) variability, Valsalva ratio, orthostatic adjustment ratio, and phase II:IV blood pressure ratio (II:IV) of the Valsalva manoeuvre were measured. All autonomic tests were compared with those of 26 healthy volunteers (19 female, mean age 37 years).
Results: Twenty nine of 49 patients were symptomatically improved. Treatment reduced those with 3 bowel actions per week (27 v 9, pre v post), need to strain (26 v 9), and laxative or suppository use (34 v 9). Biofeedback reduced retained markers by 32% in those with slow transit and by 20% in those with normal transit. Twenty two had slow transit before treatment14 felt symptomatic improvement of whom 13 developed normal transit. There was a significantly greater increase in rectal mucosal blood flow in patients who subjectively improved compared with those who did not (29% v 7%; p<0.03) and in those with improved bowel frequency (33% v 9%, increased v unchanged bowel frequency; p<0.05). Thirty five patients had abnormal RR variability and 33 an abnormal Valsalva ratio; one had an abnormal orthostatic adjustment ratio and one an abnormal II:IV ratio. None of the general cardiorespiratory autonomic reflexes was changed by treatment.
Conclusions: Biofeedback treatment affects more than the pelvic floor. Successful outcome after biofeedback treatment is associated with improved activity of the direct cerebral innervation to the gut and improved gut transit. This effect is gut specific; cardiovascular autonomic reflexes were not altered
Moderate and severe plaque psoriasis: Cost-of-illness study in Italy
No full textPsoriasis is a chronic inflammatory, immune-mediated skin disorder that affects 1.5-1.8 million people in Italy. The most common form of the disease is chronic plaque psoriasis, affecting about 90% of psoriasis patients, with about 20%-30% of them suffering from a moderate or severe condition. Little information is available about the economic impact of psoriasis in European countries. The primary objective of this study was to perform a cost-of-illness analysis of patients with moderate and severe plaque psoriasis in Italy. Therefore, direct, indirect costs, and intangible costs (quality of life - QoL) were assessed. In this national, multicenter, prospective, 3-month cost-of-illness study of moderate and severe plaque psoriasis, direct and indirect costs were assessed from the patient, third-party payer (National Health Service, NHS), and societal perspectives. From November 2003 to October 2004 consecutive patients were enrolled over a 1-year period, in order to minimize seasonal fluctuations in disease severity. 150 patients enrolled in 6 investigational sites in Italy, completed the study, and were eligible to be analyzed according to the study protocol. Intangible costs (QoL) were measured using SF36 and DLQI questionnaires. The mean total cost for psoriasis (average Psoriasis Area Severity Index [PASI] score 21.4), including direct and indirect items, was €8,371.61 per patient per year. The mean cost for patients with moderate disease (PASI ≤ 20) was €5,226.04, while the mean cost for patients with more severe disease (PASI > 20) was €11,434.40 per year. Disease heavily affected QoL measured using SF36, and the impairment was greater in patients affected by a more severe form of disease. Moderate and severe plaque psoriasis is associated with extremely high costs, which are related to disease severity. Data from this study show that the more severe plaque psoriasis, the higher the direct and indirect costs for its management. Direct costs are higher than indirect costs; hospitalization represents the most significant item, accounting for 30% of the total expenses. QoL in moderate and severe plaque psoriasis is low compared with the population at large, confirming the high impact of plaque psoriasis on QoL. The relatively high average annual costs per patient point to the need for a more efficient and long-term control of psoriasis. © 2008 Dove Medical Press Limited. All rights reserved
Relationship between psychological state and level of activity of extrinsic gut innervation in patients with a functional gut disorder
No full textBackground: Anxiety and depression are known to be associated with alterations in central autonomic activity, and this may manifest as a functional gut disturbance. However, the final expression of motility disturbance is non-specific and non-quantifiable. This study examines the relationship between psychological state and psychosocial functioning with a new direct measure of the level of activity of extrinsic autonomic gut innervation, rectal mucosal Doppler blood flow.
Materials and methods: Thirty four female patients (mean age 36 years, range 19-45) with constipation for greater than five years and 19 healthy women (mean age 38 years, range 21-60) were studied. They completed the general health questionnaire28 point scale (GHQ-28; psychosocial functioning) and the Bem sex role inventory (BSRI; an index of women's psychological feelings about their own femininity). On the same day they underwent measurement of rectal mucosal Doppler blood flow, a new validated measure of the activity of gut extrinsic nerve innervation. Measurements were made during the follicular phase and in the fasted state.
Results: Women with constipation scored higher on the total GHQ-28 score and the somatisation (p=0.05) and anxiety (p=0.05) subscales of the GHQ-28. There was a negative correlation between mucosal blood flow and GHQ somatisation subscale (r=0.45, p<0.005), anxiety (r=0.38, p<0.05), and depression (r=0.40, p<0.01) scores in women with constipation. Although constipated women scored no higher than controls on the BSRI, there was a significant negative correlation between blood flow and BSRI score (r=0.49, p<0.005) for constipated women.
Conclusions: General psychosocial function, somatisation, anxiety, depression, and feelings about female role are impaired in women with constipation and associated with altered rectal mucosal blood flow, a measure of extrinsic gut innervation. These findings suggest that psychological factors are likely to influence gut function via autonomic efferent neural pathways
Smoothed particle hydrodynamics compared to finite volume methods in highly turbulent flow: a three-dimensional analysis of a marine propeller jet case
No full textThis article may be downloaded for personal use only. Any other use requires prior permission of the author and AIP Publishing. This article appeared in D. Ferraro, J. M. Domínguez, A. Lauria, C. Altomare, F. Aristodemo; Smoothed particle hydrodynamics compared to finite volume methods in highly turbulent flow: A three-dimensional analysis of a marine propeller jet case. Physics of Fluids 1 March 2025; 37 (3): 035152. https://doi.org/10.1063/5.0256484 and may be found at https://doi.org/10.1063/5.0256484.This study presents a comparative analysis between Smoothed Particle Hydrodynamics (SPH) and Finite Volume Methods (FVMs) in simulating highly turbulent flows, focusing on a three-dimensional marine propeller jet case. The mesh-free particle-based approach and the grid-based one are evaluated for their ability to resolve complex flow structures, such as tip vortices, wake dynamics, and turbulence-induced instabilities. This paper highlights the well-established computational framework of FVM while addressing gaps in the technical literature concerning SPH, providing a guidance on computational domain construction and boundary conditions. The comparison explores key flow characteristics, including the velocity and vorticity fields, and evaluates the consistency of results between the two methods. Additionally, time-frequency analyses using Fourier and wavelet transforms of a representative velocity signal are employed to assess the methods' abilities to capture both primary and secondary harmonics. The primary goal of this study is, then, to demonstrate the potential of SPH in accurately simulating highly dynamic flows, offering valuable insight for advancing numerical simulations of marine propeller-induced flows and other turbulent fluid–structure interactions. This study provides insight into the modeling of key characteristics of the near flow field of the propeller jet wake, including the formation of tip vortices and wake structures. The SPH simulations demonstrate satisfactory agreement with FVM results in capturing the main features of the instantaneous streamwise and spanwise velocity and vorticity fields.Peer ReviewedPostprint (author's final draft
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