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Biomedical subjects

E Nunzi

Publications and source records attributed to E Nunzi.

At least 19 recordsLinked to original sources
PubMed2006

Two years' experience with Web-based teleconsulting in dermatology.

A non-commercial teledermatology network based on store-and-forward operation was established in April 2002. The aim was to create an easy-to-use platform for teleconsultation services, where physicians could seek diagnostic advice in dermatology from a pool of expert consultants and where they could present and discuss challenging dermatology cases with special emphasis on diagnosis and therapy. An online moderated discussion forum was added in October 2003. During the first two years, 348 health-care professionals from 45 countries registered to use the Website. A total of 783 requests for consultations were answered; 285 requests concerned pigmented skin lesions, 440 requests were from the whole range of clinical dermatology and 58 requests were about non-melanoma skin cancer. Of a total of 133 requests analysed, 80 (60%) were answered within one day, 47 (35%) within one week, five (4%) within two weeks and one (1%) consultation was answered in more than two weeks. Our experience with a discretionary, non-commercial, multilingual Website for open-access teleconsulting in dermatology appears to be successful. The Website represents an example of user-generated content, together with active interaction between users, who can present and discuss cases with remote colleagues.

Dermatology↗
PubMed2004

[Scrofuloderma. a clinical case].

Scrofuloderma is a form of colliquative cutaneous tuberculosis resulting from the spread of an underlying focus, generally represented by lymphnodes; osteoarticular tubercular locations or epididimus locations can also lead to ulcerative cutaneous involvement. We report the case of a female patient aged 12 who had been in Italy for 15 days following her arrival from Marocco. In the left clavicular region she presented an ulcerated lesion with palpable lymphnodes on the corresponding side of the neck. Histopathological examination of one of the involved lymphnodes suggested a mycobacteriosis; differential diagnosis was carried out between MAIS (M. avium, M. intracellulare, M. scrofulaceum) group mycobacteria infection and tuberculosis. Bacteriological research in the lymphnode of alcohol-acid resistant bacilli gave a negative result, while cultural examination and protein chain reaction pointed to M. tuberculosis. The patient was subjected to combined treatment based on rifampycin, isoniazide, etambutolol and pyrazinamide. At the present time, tuberculosis is an important public health problem in developing countries. In western countries such as the United Kingdom, which have been open to immigration for a longer time, scrofuloderma is present with higher prevalence in immigrants from Asia and Africa; in these immigrant populations, this tubercular form involves a wide age segment between the ages of 10 and 50. In the autochthonous population the highest incidence is in subjects aged more than 50. In Italy too, extra-communitary immigration has also contributed, with a delay compared to other western countries, to bring tuberculosis back into the public eye after a period of decades during which it was wrongly considered to have disappeared.

Antibiotics, Antitubercular↗
PubMed2001

Lepromatous vasculitis successfully treated by plasma exchange (PE).

Vascular involvement is presently considered a "common pathway" in a number of diseases that is mediated by circulating immune complexes (CIC). CIC are found in the circulation when the disease is active and in single patients their level may parallel disease activity. Lepromatous leprosis is characterized by the presence of CIC and deposits of immunoglobulins and complement in vascular lesions of the different organs and an Arthus-like mechanism is considered as the basis for the clinical picture. The same mechanism is considered to play an essential pathophysiologic role in Lucio's phenomenon, which is characterized by lymphohistiocytic vascular infiltrates with or without thrombosis and secondary cutaneous infarction. Lepromatous vascular involvement is mediated by CIC whose antigen composition is known, the same as it is with HCV mediated cryoglobulinemia, HBV positive panarteritis nodosa, rheumatoid vasculitis, or Wagner's granulomatosis, which are usually treated by PE [1-3]. PE has been employed for lepromatous vasculitis since 1979 [4] and other cases have been successfully treated afterwards [5,6]. We report on another patient successfully treated by plasma exchange.

Humans↗
PubMed2000

US and MR imaging of peripheral nerves in leprosy.

OBJECTIVE: To analyze peripheral nerves with ultrasonography (US) and magnetic resonance imaging (MR) in leprosy and assess the role of imaging in leprosy patients. DESIGN AND PATIENTS: Fifty-eight nerves with abnormal clinical features or electromyograms were examined in 23 leprosy patients by means of gray-scale US, Doppler US and MR imaging. Image analysis included: measurement of nerve cross-sectional area; assessment of nerve structure and MR signal intensities; identification of nerve compression within osteofibrous tunnels; detection of endoneural color flow signals and Gd-DTPA enhancement. Correlations were made with clinical findings and a control group of 20 subjects. Fourteen nerves in active reversal reaction were followed up after therapy. RESULTS: Leprosy nerves were classified into three groups based on imaging appearance: group I consisted of 17 normal-appearing nerves; group II, of 30 enlarged nerves with fascicular abnormalities; group III, of 11 nerves with absent fascicular structure. Group II nerves were from patients subjected to reversal reactions; 75% of patients with group III nerves had a history of erythema nodosum leprosum. Nerve compression in osteofibrous tunnels was identified in 33% of group II and 18% of group III nerves. Doppler US and MR imaging were 74% and 92% sensitive in identifying active reactions, based on detection of endoneural color flow signals, long T2 and Gd enhancement. In 64% of cases, follow-up studies showed decreased color flow and Gd uptake after steroids and decompressive surgery. CONCLUSIONS: US and MR imaging are able to detect nerves abnormalities in leprosy. Active reversal reactions are indicated by endoneural color flow signals as well as by an increased T2 signal and Gd enhancement. These signs would suggest rapid progression of nerve damage and a poor prognosis unless antireactional treatment is started.

Adolescent↗
PubMed1998

Acrokeratoelastoidosis of Costa: a primary disease of the elastic tissue?

A 24-year-old black woman from Uganda was seen for treatment of multiple papules on her hands and feet. The lesions corresponded microscopically to foci of hyperkeratosis and acanthosis. Acid orcein stain revealed marked elastic fiber fragmentation. Acrokeratoelastoidosis of Costa (AKE) was diagnosed. The same damage to the elastic fibers was also present in an additional specimen from grossly uninvolved skin. On electron microscopy there were pronounced changes of the elastic fibers with elastolysis in both specimens. This case with generalized damage of the dermal elastic tissue supports the view that elastorrhexis is the key feature of AKE. Accordingly, the disease could be regarded as a primary elastic tissue disorder. The marginal acral keratoderma that is seen in AKE patients could represent epidermal changes secondary to chronic trauma.

Adult↗
PubMed1998

beta 2-Glycoprotein I-dependence of anticardiolipin antibodies in multibacillary leprosy patients.

This study was undertaken to investigate the influence of beta 2-glycoprotein I (GPI) on anticardiolipin antibody (aCL) titration in leprosy. The study group consisted of 140 sera from patients with multibacillary leprosy (46 borderline, 94 lepromatous). The group included newly diagnosed, previously untreated patients, patients under treatment and patients released from treatment. GPI addition enhanced significantly the aCL titres in sera from lepromatous leprosy but not in those from borderline leprosy. Moreover, when the patients were classified according to their bacteriological status, aCL titres were found to be significantly higher in skin smear positive patients compared to bacteriologically negative patients. Thus, the present study demonstrates that aCL in multibacillary leprosy patients are mainly of the GPI-dependent type and emphasizes the importance of GPI addition for aCL titration in leprosy.

Analysis of Variance↗
PubMed1995

Short report: erythema nodosum leprosum lymphadenitis.

A case of isolated erythema nodosum lymphadenitis involving the paravertebral, intercostal, and cervical lymph nodes without concomitant skin involvement is reported in a 62-year-old male patient under treatment for lepromatous leprosy.

Erythema Nodosum↗
PubMed1990

[Multibacillary atypical mycobacteriosis].

A case of atypical multibacillary mycobacteriosis is described. The differential diagnosis is discussed on the basis of clinical, microbiological and histopathological parameters.

Adolescent↗
PubMed1989

[Anti-nDNA antibodies in lupus erythematosus].

Using the ELISA technique we have tested anti-nDNA antibodies in 79 patients affected with Lupus Erythematosus. The same patients have previously been tested for anti-cardiolipin antibodies. According to the literature, cross inhibition ELISA tests show no cross reactions between these two auto-antibodies families. Patients with highest anti-nDNA antibodies show a production of polyclonal (IgG, IgM, IgA) antinuclear antibodies responsible for a homogeneous pattern detected by indirect immunofluorescence.

Adult↗
PubMed1989

Traumatic eosinophilic ulcer of the oral mucosa.

A typical case of eosinophilic ulcer of the tongue is described. It confirms the traumatic cause for this benign, self-healing lesion that may be misdiagnosed and clinically confused with squamous cell carcinoma. The short time that the lesion takes to heal is an important diagnostic clue in differentiating eosinophilic ulcer of the tongue from cancer, thus sparing the patient unnecessary surgery or radiation therapy. The histopathologic pattern is also diagnostic. We prefer to call this lesion traumatic ulcer of the oral mucosa.

Aged↗