43 research outputs found
Is the Delphi's Oracle Pertinent to Patients With Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma?
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Erythema nodosum as symptom of systemic diseases
No full textIntroduction: Erythema nodosum (EN)is the most common panniculitis in childhood. The lesions of EN are localized at the lower limbs, in particular in the pretibial region, while upper limbs and trunk are rarely involved. Erythema nodosum can be associated with general symptoms such as fever, weakness, and severe pain, but skin lesions resolve without skin damage.
Objectives: To describe five cases of Erythema nodosum in childhood
Methods: R.G. f. 3 years old came to our department for a two week history of fever (up to 38 °C) and skin lesions. Physical examination revealed pharyngeal hyperemia and multiple erythematous nodules on the extensor surface of the lower extremities. Laboratory tests showed an elevation of ESR(35 mm/h) and CRP, (1,06 mg/dL) and high levels of Chlamydia Pneumoniae IgM.Throat swab was negative for group A beta-hemolytic Streptococcus (GAS) and her chest X-ray was negative. So antibiotic therapy was prescribed and symptomatology improved.
A.N. m. 8 years old was hospitalized for fever up to 39 °C and skin lesions in the lower limbs. Patient suffered from recurrent abdominal pain and diarrhea. Physical examination revealed abdominal pain and erythematous and painful nodules in pretibial region of both lower limbs. Blood tests showed increase of ESR (40 mm/h) and CRP (1,3 mg/dL). Blood examinations for celiac disease were negative. Fecal calprotectin was high (500 mg/kg). Abdomen ultrasound revealed terminal ileum bowel wall thickening. Crohn’s Disease (CD)was suspected and confirmed with an endoscopy including biopsies.
A.N. f. 5 years old was admitted to our department for fever (38 °C) and skin lesions that started two weeks ago. The patient also had 1 month history of cough. Physical examination revealed: pharyngeal hyperemia, cervical and axillary lymphadenopathy and skin lesions suggestive of erythema nodosum on the extensor parts of both lower limbs. Inflammatory tests were increased (ERS 28 mm/h, CRP 1,5 mg/dL). Her chest X-ray was negative. Mantoux test was positive with an induration of 15 millimeters (mm) after 48 hours and 18 mm after 72 hours, also a Quantiferon test was positive.
L.B. f. 12 years old had an history of fever, headache, fatigue, joint pain and skin lesions.The objective examination revealed: malar rash, arthritis of the right knee, erythematous nodules on the extensor surface of the lower limbs. Blood tests showed anemia (Hb,5 g/dL), thrombocytopenia (PLT 75.000/mm3), ERS increased (30 mm/h) positive ANA, antiDNA. Systemic Lupus Erythematous was diagnosed according to ACR criteria
I.L. f. 8 months old had a two months history of recurrent fever and skin lesions. On admission the patient was febrile (TC 38 °C). Physical examination revealed pharyngeal hyperemia, splenomegaly and erythematous nodules on the extensor surface of the lower limbs.Inflammatory tests were increased (ERS 33 mm/h, CRP 2 mg/dL). Antibodies anti CMV, EBV, Chlamydia and Mycoplasma Pneumoniae were negative. Biopsy of a lesion showed a condition compatible with panarteritis nodosa.
Results: EN is a skin inflammatory reaction. EN could be associated with infectious diseases (GAS, Chlamydia Pneumoniae, Mycoplasma Pneumoniae, Epstein-Barr virus, Mycobacterium Tuberculosis), drugs, inflammatory bowel diseases, rheumatologic diseases, malignant tumor.
Conclusion: The presented cases show that erythema nodosum can be secondary to different diseases.In the diagnostic process associated symptomatology and laboratory tests should be considered to diagnose the disease and to start specific treatmen
Isolated lung metastases from pancreatic ductal adenocarcinoma (PDAC): Diagnostic and therapeutic challenges of a different disease
No full textPancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, mostly due to the high rate of distant dissemination. However, growing evidence shows that isolated lung recurrence or metastases (ILM) from PDAC are not only less common, but also correlated with a better prognosis. Lung-only recurrence after surgery occurs later in time and is associated with more favorable prognostic characteristics of the primary tumor. Moreover, recent findings suggest that this specific site of metastases is characterized by an immunologically “hot” microenvironment and a more favorable molecular profile that could possibly justify its clinical behavior. Thus, ILM from PDAC emerge as a distinct entity, that might also benefit from a different therapeutic approach, possibly with the integration of surgery and de-intensified chemotherapy regimens, especially in selected patients. In this review we delve into the current scientific evidence on the clinical and biological characteristics of isolated LM from PDAC, also focusing on concerns with their diagnostic process and the therapeutic options for the management of this subset of patients
Effetti sul metabolismo osseo e sulla composizione corporea dei farmaci anticonvulsivanti: studio caso-controllo in pazienti in monoterapia con acido valproico e carbamazepina.
No full textPremessa:
Gli effetti negativi dei farmaci antiepilettici (AEDs) sul metabolismo osseo sono noti fin dagli anni sessanta, quando furono pubblicati i primi studi.
Essi riguardavano principalmente i farmaci di prima generazione, in particolare il fenobarbital e la fenitoina. Più recentemente, simili effetti collaterali sono stati riscontrati anche per i farmaci così detti di seconda generazione, come carbamazepina (CBZ) e acido valproico (VPA).
I meccanismi risultanti nella diminuzione della densità ossea non sono ancora stati totalmente chiariti, benché, negli anni, siano state proposte molte teorie; il principale responsabile di questo importante effetto collaterale, è stato considerato l'induzione esercitata dai così detti farmaci “enzyme-inducing” (categoria alla quale appartengono molti dei farmaci antiepilettici come il fenobarbital e la carbamazepina) sull'enzima mitocondriale citocromo P450, accelerando così il metabolismo della vitamina D3 nei suoi metaboliti inattivi.
Questa teoria non è in grado di spiegare però, il motivo per il quale anche farmaci non-enzyme-inducing ( l'acido valproico in primis) mostrino degli effetti sul metabolismo fosforo-calcico.
La conclusione di numerosi studi è quindi che gli AEDs possano agire sull'equilibrio fosforo-calcico a più livelli, ad esempio interagendo negativamente con l'equilibrio osteobalsti-osteoclasti, diminuendo l'assorbimento intestinale del calcio, agendo sull'inibizione della risposta cellulare al PTH, sull'induzione di un iperPTH e infine tramite una diminuzione della produzione della calcitonina.
E' chiaro come qualsiasi elemento che perturbi l’equilibrio del metabolismo osseo durante la fase di accrescimento in età pediatrica, impedisca il raggiungimento di un adeguato PMO, diventando un importante fattore di rischio iatrogeno per le fratture e predisponendo alla malattia osteoporotica nell'età adulta.
Un altro effetto collaterale recentemente indagato è l'azione dei farmaci anticonvulsivanti sull'omeostasi fisiologica degli ormoni: questo avviene perché la maggior parte di essi determina una blocco dei canali voltaggio-dipendenti del sodio e dei canali del calcio, o un incremento della trasmissione GABAergica e/o un'azione antagonista sui recettori del glutammato.
E' ragionevole aspettarsi che questi meccanismi influenzino la secrezione degli ormoni ipotalamici come il GnRH ( gonadotropine releasing hormone) il CRH (corticotropic-releasing hormone ) il GRH e il TRH.1
Le modificazioni della fisiologia ormonale potrebbero condurre i pazienti a sviluppare patologie metaboliche importanti, manifestantesi con un aumento di peso e del BMI, e quindi allo sviluppo di insulino-resistenza con modificazioni dei parametri metabolici come LDL, HDL e trigliceridi.
Materiali e Metodi:
Sono stati arruolati per questo studio, 20 pazienti della Clinica Neuropediatrica, in monoterapia con acido valproico o carbamazepina.
Essi sono stati sottoposi a densitometria ossea (DXA), per poterne valutare i parametri di contenuto osseo, densità ossea, e composizione corporea.
I valori ottenuti sono stati comparati con i valori dei casi-controllo.
E’ stata effettuata un’analisi di varianza (ANOVA) sia tra i campioni “pazienti in terapia” e “casi-controllo” che tra “pazienti in terapia con CBZ” e “pazienti in terapia con VPA” e “pazienti femmine in terapia” con “pazienti maschi in terapia”.
Successivamente abbiamo cercato eventuali correlazioni tra il tempo di terapia e l’età di inizio della terapia con le altre variabili con l’utilizzo del coefficiente di Pearson.
Risultati:
Si può osservare dall'analisi statistica, l'emergere di una significativa differenza (p <0,0283) tra i pazienti che assumono terapia con AEDs e i casi controllo, per quanto riguarda il L- BMDv Z-score.
Questo dato è molto interessante sia perché il BMD volume, nei bambini e negli adolescenti è il fattore maggiormente indicativo della densità ossea perché indipendente dalla statura, sia perché, nella maggior parte degli studi effettuati, il sito maggiormente interessato dall'azione di entrambi farmaci è la colonna lombare.
Gli effetti che si sono potuti osservare nel nostro studio di VPA e CBZ sulla composizione corporea sono statisticamente molto significativi: si ritrova infatti, sia un aumento della Massa grassa Kg (p < 0,006) che percentuale (p < 0,0007) rispetto ai controlli sani.
Nonostante non sia stato evidenziato un aumento significativo del BMI e del BMI SDS, e sia risultata non significativa la differenza tra l'acido valproico e la carbamazepina nel determinare l’effetto, possiamo comunque concludere come vi sia un’azione negativa dei farmaci antiepilettici sulla massa grassa.
Alla luce di ciò, appare verosimile come, ampliando il campione a nostra disposizione e prendendo un data set più omogeneo, si potrebbero
determinare ulteriori effetti negativi dei farmaci oggetto dello studio
BLOOD PRESSURE CONTROL HAS DISTINCT EFFECTS ON EXECUTIVE FUNCTION, ATTENTION, MEMORY, AND MARKERS OF CEREBROVASCULAR DAMAGE. RELEVANCE FOR EVALUATING THE IMPACT OF ANTIHYPERTENSIVE TREATMENT ON COGNITIVE DOMAINS.
No full textHypertension causes cognitive impairment, involving mainly executive functions, but the effect of blood pressure (BP) control on the different cognitive domains is still debated. We correlated executive function, attention and memory with BP control and cerebrovascular damage in 60 undemented middle-aged hypertensives at baseline and after 6-year follow-up. At first evaluation, the patients with poor BP control had higher score of white matter lesions, reduced cerebrovascular reserve capacity and greater carotid intima-media thickness (IMT) than those with good BP control. Performance on executive tests correlated with IMT and with performance on attention tests, which was impaired by low diastolic BP. At long-term follow-up, performance in attention and executive tests improved in spite of the minor improvement of BP control, increased IMT and worse memory. Low diastolic BP has a negative effect on attention, which affects executive performance at first cross-sectional examination. This confounding effect has to be taken into consideration when planning studies on cognitive function. Longitudinal studies are required to unravel the effect of BP control on cognitive function, as only long-term antihypertensive treatment improves both attention and executive performanc
Acute Kidney Injury in Children with Acute Appendicitis
No full textWe hypothesized that—as in other common pediatric conditions—acute appendicitis (AA) could be complicated by acute kidney injury (AKI). We aimed to investigate the prevalence of, and the factors associated with AKI in a cohort of patients with AA. We retrospectively collected data of 122 children (63.9% of male gender; mean age 8.6 ± 2.9 years; range: 2.2–13.9 years) hospitalized for AA. AKI was defined according to the Kidney Disease/Improving Global Outcomes creatinine criteria. We considered a basal serum creatinine value as the value of creatinine estimated with the Hoste (age) equation, assuming that the basal estimated glomerular filtration rate (eGFR) was 120 mL/min/1.73 m(2). Explorative univariate logistic regression analysis was used to explore the associations with AKI. Out of 122 patients, nine (7.4%) presented with AKI. One patient had stage two AKI and the remaining had stage one AKI. The maximum AKI stage was found at admission. The patients with AKI showed a higher prevalence of fever ≥ 38.5 °C (p = 0.02), vomiting (p = 0.03), ≥5% dehydration (p = 0.03), and higher levels of both C-reactive protein (CRP) (p = 0.002) and neutrophils (p = 0.03) compared with patients without AKI. Because all patients with AKI also presented with vomiting, an Odds Ratio (OR) for the vomiting was not calculable. The exploratory univariate logistic regression analysis confirmed that fever ≥ 38.5 °C (OR = 5.0; 95% CI: 1.2/21.5; p = 0.03), ≥5% dehydration (OR = 8.4; 95% CI: 1.1/69.6; p = 0.04), CRP (OR = 1.1; 95% CI: 1.05/1.2; p = 0.01), and neutrophil levels (OR = 1.1; 95% CI: 1.01/1.3; p = 0.04) were all predictive factors of AKI. AKI can occur in 7.4% of patients with AA. Particular attention should be paid to the kidney health of patients with AA especially in the presence of vomiting, ≥5% dehydration, fever ≥ 38.5 °C, and high CRP and neutrophils levels
