Recent advances in targeting BRAF mutations, which occur in roughly 50% of the melanomas, have improved response rates and overall survival in patients with advanced disease. With the increasingly extensive use of the drug, new, nonpreventable, cutaneous and noncutaneous toxicities keep arising as infrequent adverse effects. We report a 55-year-old man with a history of metastatic melanoma treated with the dabrafenib who presented, 10 months after the initiation of the treatment, with erythematous, slightly squamous, round plaques on his upper trunk and on his left upper arm. Two skin biopsies from the lesions revealed a granulomatous dermatitis in the superficial reticular dermis. One of them showed admixed abundant melanophages from tumoral melanosis. No melanoma cells were seen in any of the specimens. No interruption of the treatment was necessary. Our observation indicates that such a response may represent a positive immune activation triggered by BRAF inhibitors. The erythematous rash was initially concerning for progression of metastatic disease, which suggests that a close monitoring of the patients with advanced melanomas treated with vemurafenib is advisable to prevent unnecessary discontinuation of the therapy.
Basal cell carcinoma (BCC) is the most common malignancy in Caucasians, and its incidence is increasing. Most BCCs are treated surgically, nevertheless surgery is not an effective treatment for locally advanced or metastatic BCC. Alterations in hedgehog signaling pathway, a key regulator of cell growth and differentiation during development, are implicated in the pathogenesis of basal‐cell carcinoma. Vismodegib is a small‐molecule inhibitor of smoothened (SMO), a key component of the hedgehog (Hh) signaling pathway, administered in BCC patients, especially when surgery and radiotherapy treatments have failed. We report a series of eight elderly patients treated with vismodegib for advanced BCC and affected by concomitant multiple comorbidities. The efficacy and tolerability of vismodegib in patients with single and/or multiple comorbidities has been poorly studied. In our observation an overall high safety and tolerability has been observed over the course of treatment, with side effects of grade I and II and no changes in vital parameters, electrocardiography and echocardiogram. Vismodegib has been shown to be a safe and well tolerated treatment option for elderly patients affected by multiple comorbidities and advanced BCC.
Purpose To report long-term outcomes of strabismus surgery for treatment of third nerve palsy. Methods We performed a 15-year retrospective study of patients who had undergone surgery. We analyzed preoperative mean deviation (at 6 months, 1 year after surgery, and at the end of follow-up), type of surgery, and factors predicting outcomes. A final deviation <10 prism diopters (pd) was considered a good esthetic outcome, and no diplopia in the primary position at the end of follow-up was considered a good functional outcome. Results Surgery was performed in 31 cases. Mean age was 36.27 years (women, 51.6%). Total and complete third nerve palsy was recorded in 22.6% and acquired palsy in 80.6%. Mean preoperative horizontal deviation (HD) in primary position was 40.24 pd (near) and 44.29 (distance) and 14.33 pd in vertical deviation (VD). Mean final HD was 8.94 pd (near) and 11.35 pd (distance), and mean final VD was 6.13. One surgery was performed in 68.9%. A favorable esthetic outcome was obtained in 64.5% and a successful functional outcome in 72.2%. Statistically significant differences were found between near HD ( p = 0.019) and distance HD ( p = 0.035) at 1 year compared with the end of follow-up and between VD at 6 months and 1 year after surgery ( p = 0.03). Mean follow-up was 6.05 years. No specific factors predicted a successful outcome. Conclusions Esthetic and functional results were similar. No predictors of successful outcome were identified. HD was better 1 year after surgery, and VD improved during follow-up.
Objectives: The purpose of this study was to describe the ophthalmologic manifestations found in patients with autism spectrum disorder (ASD) and to assess their prevalence in the different types of ASD. Materials and Methods: This prospective observational study included 344 patients with ASD seen over a period of 8.5 years. They were classified into four subgroups (autism, Asperger syndrome, pervasive developmental disorders not otherwise specified [PDD-NOS], and other). Data obtained from ophthalmological examinations were compared between the groups. Statistical analysis was performed with chi-square, Kruskal-Wallis, and Mann-Whitney tests. Results: Refractive defects were detected in 48.4% of the patients, with the most prevalent being hyperopia and astigmatism. There was a higher prevalence of myopia in Asperger syndrome. Evaluation of extraocular motility revealed the presence of strabismus in 15.4% of patients, with a statistically significantly higher prevalence in autism and the “other” disorders group. The most frequent type of strabismus was exotropia. Convergence was found to be normal in 43.6% of the patients. Nystagmus was observed in only 0.9% of patients. In the binocular sensory tests performed, patients with Asperger syndrome had significantly better results compared to the other groups. Optic nerve abnormalities were found in 4% of patients, with significantly higher prevalence in the “other” disorders group. Conclusion: Ophthalmologic manifestations occur more frequently in patients with ASD than in the general child population. Of these, the most frequent are refractive defects and ocular motility disorder. Therefore, we consider it necessary to perform an ophthalmological evaluation in patients with ASDs.
<p>Before modern remote sensing techniques, quantifying rock wall retreat due to rockfall events in the high alpine environment was limited to low-frequency post-event measurements for high-magnitude events. LiDAR and SFM now provide precise and accurate 3D models for computing 3D volume changes over time. Otherwise, mid- and low-sized events can remain unobserved due to the remoteness of the rockwalls and the lack of remnant evidence due to the rapid sequestration of ice in surrounding valley and cirque glaciers. To extend rockfall event measurement an initial measurement (t0) is necessary. The Mont-Blanc Massif (MBM, European Alps) High Resolution Topography Project is currently completing high-precision 3D models in the MBM using ground-based and aerial LiDAR, and drone-based structure-from-motion (SFM). In 2021, we began acquisition with initial measurements of 11 major sectors of the massif, representing about 80 km<sup>2</sup> of rock and ice slopes, between 1700m - 4810m in elevation. By choosing a study area with robust existent photographic and film archives, such as the MBM, it is possible to extend 3D models back in time for comparison with current datasets. Despite existent high-quality image archives, SFM processing is more challenging and error-prone than from contemporary images due to a lack of metadata, such as camera and lens type, precise dates of images, and the general degradation of the original material. &#160;Despite these limitations, the use of historical-image-based SFM in combination with modern LiDAR data can allow the reconstruction of significant slopes of the MBM over several decades in order to i) obtain estimates of erosion rates, ii) to document rockfall events, and iii) to quantify the extent change and volume loss of hanging glaciers and ice aprons. We thus explore geomorphic processes in the high mountain environment in context of warming climate, as well as the limits of input data (image sets) in terms of practical output resolution.</p>
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