Italian Clinical Practice Guidelines on Cholangiocarcinoma – Part II: Treatment

Currently, the only curative treatment for cholangiocarcinoma (CCA) is surgical resection, though this treatment is possible in less than 40% of patients. However, recent improvements in preoperative management have led to a higher number of patients who are candidates for this procedure. For unresectable patients, progress is ongoing in terms of locoregional and chemoradiation treatments and target therapies, especially in the definition of patient selection criteria. This is the second part of the Italian CCA guidelines, dealing with CCA treatment, that have been formulated in accordance with Italian National Institute of Health indications and developed according to the GRADE method and related advancements.     

Autoimmune bullous diseases in skin of color

Dermatologic health care disparities disproportionately affect patients with skin of color (SoC), defined as Fitzpatrick skin phototypes IV-VI (light brown, brown, and black skin tones), resulting in delayed treatment and increased morbidity and mortality.¹ Numerous studies predict that by 2060 the White race will be a minority in the United States. Despite the rising SoC population, there remains a scarcity of peer-reviewed literature depicting skin conditions in SoC. In 2006, autoimmune

Bullous pemphigoid

Bullous pemphigoid (BP) is the most common AIBD, with a reported incidence of 2.4 to 23 cases/1,000,000.⁵ BP prevalence is an estimated 12/100,000.⁶ It affects patients 60 to 80 years old with a 1-year mortality of 20%.⁷BP is characterized by tissue-bound and circulating IgG autoantibodies against hemi-desmosomal anchoring proteins, BP180 and BP230.⁸ Diagnosis is confirmed via lesional biopsy, showing a subepidermal bulla with eosinophils in the infiltrate, and perilesional direct

Conclusions

AIBD in SoC patients have heterogeneous clinical presentations with features that may not be readily recognized. These can range from the color of erythema on darker skin types to postinflammatory hyperpigmentation, sometimes being confused for other disorders, as commonly observed with BP and PV. In DH, erythema may not be as pronounced in darker skin types, but even when it is, varied histologic features may create confusion about the clinical diagnosis. There may be some genetic associations

     

Antiseptic Compounds Still Active Against Bacterial Strains Isolated from Surgical Wound Infections Despite Increasing Antibiotic Resistance

The in vitro activities of povidone iodine, potassium peroxymonosulfate, and dimethyldidecylammonium chloride were investigated against 379 nosocomial isolates of Staphylococcus aureus and Pseudomonas aeruginosa responsible for surgical wound infections in patients operated on between July 1995 and June 2001. Overall, the isolates were inhibited by the antiseptics at concentrations below those used routinely. In spite of increasing resistance to the various antibiotics used to treat surgical wound infections, no significant variation in the susceptibility to antiseptics was demonstrated during this 6-year study. Electronic Publication     

Triage of disaster-related neuropsychiatric casualties

Existing triage algorithms consider, for the most part, only the primary casualty with physical trauma. Algorithms fail to appreciate the primary, secondary, or tertiary neuropsychiatric casualty. Research advances on neuropsychiatric casualties must link with the mandates of emergency medical services and disaster management to improve triage sensitivity and specificity. Early recognition and management of neuropsychiatric casualties will diminish the potential for long-term consequences. Expanded triage algorithm supplements are proposed to improve the recognition of those victims at risk.     

Maximized combined modality treatment of an unselected population of oral and oropharyngeal cancer patients. Final results of a pilot study compared with a treatment-dependent prognosis index.

BACKGROUND: In an attempt to raise the survival of an unselected and representative population of oral and oropharyngeal squamous cell cancer patients, a pilot study of an integrated four-modality treatment was conceived. Final endpoints were compliance, loco-regional control, survival (after complete 5-year follow-up), and a concept of trial assessment using the treatment-dependent prognostic index TPI. PATIENTS: Eighty-seven consecutive patients with histologically proven untreated stages I-IV disease presented in the period between 1997 and 1999 of whom 14 had to be considered uncurable and 73 were fit to be treated with the intention of achieving a cure. METHODS: All patients received one cycle of neoadjuvant intraarterial chemotherapy with 150 mg/m(2) cisplatin (systemically neutralized with sodium thiosulphate), and, if possible, by consecutive treatment applying both surgery of the primary tumour and the neck lymphatics, as well as by adjuvant radiation over 5 weeks (51.3 Gy) plus concurrent chemotherapy (weekly systemic docetaxel 25 mg/m(2)). RESULTS: Ninety per cent of all cases and 96% of the patients treated with curative intention received more than one modality due to study design. Patient non-compliance in the group treated with curative intention has been 18/73 (=25%), and protocol compliance has been 32/73 (=44%). The locoregional control rate for all cases was 71% (62/87 patients) and for the patients treated with curative intention 83.5% (61/73 patients). Thirteen/fourteen non-curable patients died after a mean period of 4 months. After a median observation time of 5 years, the final absolute survival of the unselected population was 53%, and of the patients treated with curative intention 62% (especially, 70% and 50% for patients with operable stages III and IV, respectively). CONCLUSION: The multimodality regimen as presented proved feasible and showed high objective and relative survival rates in comparison with known data from tumour registries of unselected populations. Intra-arterial chemotherapy should be considered a valuable addition to treatment. The potential of survival benefit from this multimodality regimen in comparison with the prognosis index TPI should be investigated in further studies.