Severe palmoplantar erythrodysesthesia and intertrigolike eruption induced by polyethylene glycol-coated liposomal doxorubicin.
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Biomedical subjects
Publications and source records attributed to A Campanelli.
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Calcifying panniculitis is a rare form of calcinosis cutis belonging to the spectrum of calciphylaxis that has almost invariably been described in patients with severe renal disturbances. We report a patient with osteomalacia without chronic renal failure, who developed calcifying panniculitis following subcutaneous administration of nadroparin-calcium. Light microscopy studies of biopsy specimens revealed multiple foci of microcalcification within the adipose lobules, in the interadipocyte spaces, in connective tissue septa and in the media of small arteries in the subcutis. The patient had an elevated level of intact parathyroid hormone, whereas the calcium-phosphorus product was normal. The lesions slowly resolved upon discontinuation of nadroparin. We conclude that calcifying panniculitis is a rare complication associated with the subcutaneous administration of nadroparin-calcium that may rarely also occur in the absence of renal disturbances. Low molecular weight calcium-containing heparins should probably be used with caution in the presence of hyperparathyroidism.
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Fulminant herpetic sycosis is a rare but well-known manifestation of herpes simplex virus (HSV) infection occurring in the context of viral recurrence in immunodepressed patients. We present here the case of a 32-year-old male patient, without notable medical history, who developed papulovesicular lesions of the beard accompanied by fever, painful cervical lymphadenopathy and odynophagia, with a clinical evolution that was initially unfavourable under antibiotic treatment. The diagnosis of herpetic sycosis was established by means of direct immunofluorescence and culture which confirmed positivity for HSV-1 and serologies compatible with a primary viral infection. No sign for a latent immune deficit was found at the time of investigations. The clinical evolution was rapidly favourable with administration of intravenous aciclovir for 1 week. To our knowledge, herpetic sycosis as a presentation of primary viral infection has not been reported previously. The possibility of a herpetic sycosis of the beard must be considered in the case of non-response to antibiotic or antifungal treatment.
Personal experience on a particular utilization of circular stapler is reported. At the beginning the fast and easy execution emphasized its use. However, the constant appearance of a late complication was observed, i.e. the progressive stenosis of the stoma. This event occurred even when maximal size of the instrument was used and it reappeared after repeated procedures of instrumental or surgical dilatation. The effective validity of this technique was evaluated by the Authors. On the other hand, the Burk alternative technique, with a second purse-string on the cutaneous ring seems to prevent the stenosis. However, it is slow and difficult as traditional procedure. The causes of the neostoma stenosis performed by circular stapler, reported by the Authors in 100% of cases, are easily explained with the absence of biological barrier of colonic mucosa that normally prevents excessive tissue growth.
After a careful review of the literature and a critical evaluation of personal experience on stapling technics in visceral anastomoses, some critical considerations on circular devices are reported. The Authors emphasize the well known qualities of staplers which brought to their routine use in digestive surgery. Some complications exclusively due to an "imperfect" firing of the instrument are then reported. Personal experience on a particular utilization of circular stapler for definitive colostomy is also reported. The Authors finally suggest some simple technical improvements.
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In this paper the Authors consider the epidemiological, clinical, pathological, instrumental, chemical and physical findings of every type of pancreatic cystic lesions. They perform a critical examination of each of them. In this way, they can identify the most important features of every single class. A pathway consisting in four main groups of instrumental and chemical tests (abdominal ultrasonography / EUS, CT, MR, FNA / biopsy/ assay of tumoral markers and amylase of cystic fluid) was chosen to know all these informations according to careful principles of specificity, sensitivity and diagnostic accuracy taken from international scientific literature. In each subgroup of cystic pancreatic tumor, at last, the most reliable therapeutic project is suggested according to the common international scientific agreement.
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