Ospedale San Giovanni Bellinzona

Exercise-induced purpura is a distinctive condition occurring after prolonged physical exertion. It is often misdiagnosed as an immune-mediated vasculitis, raising concerns about autoimmune disorders. Although this condition affects physically active individuals, it remains underrepresented in comprehensive reviews on purpura and nontraumatic sports dermatology. To enhance awareness about this condition and to advance understanding of its clinical and histologic features, we conducted a systematic literature review. This study was preregistered in the International Prospective Register of Systematic Reviews (CRD42024557652). The United States National Library of Medicine, Excerpta Medica, and Google Scholar were screened for the terms "exercise-induced vasculitis" OR "exercise-induced purpura" OR "exercise-induced capillaritis." Data extraction encompasses demographics, symptoms, time latency and recovery, predisposing factors, ancillary tests (blood values and histology), and popular terminology. We identified 40 typical cases and three case series reporting an additional 71 individuals. Exercise-induced purpura predominantly affected middle-aged women, often in association with chronic venous disease. Petechiae, purpura, or ecchymoses-often accompanied by burning, itching, or mild pain-appeared within 24 hours after prolonged physical activity, especially in warm conditions, and characteristically involved the lower limbs, sparing areas covered by clothing. Symptoms and lesions resolved spontaneously within 1 to 2 weeks. Laboratory tests were unremarkable, and histology revealed leukocytoclastic vasculitis without IgA deposits. Exercise-induced purpura deserves greater visibility in sports medicine due to its frequency, benign course, and potential for misdiagnosis. Diagnosis is clinical. Early recognition avoids unnecessary investigations and unwarranted concern.

We assessed the benefit of adjuvant aspirin in patients with resected phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-mutated colon cancer. This was a phase III, prospective, randomized, placebo-controlled, double-blind, multicenter, and multinational trial. Patients with resected colon cancer stage II and III harboring an activating PIK3CA mutation were included. Because of financial constraints, the trial was prematurely closed. Randomization was 2:1 to aspirin 100 mg versus placebo daily for 3 years. The primary endpoint was disease-free survival (DFS). Secondary endpoints included the time to disease recurrence (TTR), overall survival, and adverse events. Overall, 1,040 patients were screened for PIK3CA mutations, with 112 randomized to aspirin (N = 74) and placebo (N = 38). The median age was 66 years, and 42.9% were female. After a median follow-up of 4 years, 19 DFS events occurred, including 10 in the aspirin and nine in the placebo arm. The HR for DFS was 0.57 [90% confidence interval (CI), 0.27-1.22], in favor of aspirin (P = 0.11). DFS rates at 5 years were 86.5% (90% CI, 77.7%-92.0%) in the aspirin and 72.9% (90% CI, 55.7%-84.3%) in the placebo arm. The HR for TTR was 0.49 (90% CI, 0.21-1.19, P = 0.089) in favor of aspirin. No patient experienced aspirin-related serious adverse events. The SAKK 41/13 is the first randomized trial to provide clinical evidence of a protective effect of adjuvant aspirin in patients with resected PIK3CA-mutant colon cancer, with clinically relevant DFS and TTR improvements. Although results were not statistically significant because of premature study closure, adjuvant aspirin warrants individual consideration in patients with resected PIK3CA-mutant colon cancer stage II and III. See related commentary by Drew et al., p. 3107.

No abstract available.

Ce numéro des Cahiers de la Méditerranée est né de la volonté d’analyser un certain nombre de discours produits au xixe siècle et au début du xxe siècle sur l’émancipation des femmes en Italie dans toute leur variété et leur complexité. Il rassemble une partie des interventions présentées lors du colloque consacré à La question de l’émancipation des femmes en Italie (1815-1930), organisé par le Laboratoire d’études romanes de l’Université Paris 8 et qui s’est tenu en ligne les 19, 20 et 21 m...

Background: Device patients may require upgrade interventions from simpler to more complex cardiac implantable electronic devices. Prior to upgrading interventions, clinicians need to balance the risks and benefits of transvenous lead extraction (TLE), additional lead implantation or lead abandonment. However, evidence on procedural outcomes of TLE at the time of device upgrade is scarce. Methods: This is a post hoc analysis of the investigator-initiated multicenter Swiss TLE registry. The objectives were to assess patient and procedural factors influencing TLE outcomes at the time of device upgrades. Results: 941 patients were included, whereof 83 (8.8%) had TLE due to a device upgrade. Rotational mechanical sheaths were more often used in upgraded patients (59% vs. 42.7%, p = 0.015) and total median procedure time was longer in these patients (160 min vs. 105 min, p < 0.001). Clinical success rates of upgraded patients compared to those who received TLE due to other reasons were not different (97.6% vs. 93.0%, p = 0.569). Moreover, multivariable analysis showed that upgrade procedures were not associated with a greater risk for complications (HR 0.48, 95% confidence interval 0.14–1.57, p = 0.224; intraprocedural complication rate of upgraded patients 7.2% vs. 5.5%). Intraprocedural complications of upgraded patients were mostly associated with the implantation and not the extraction procedure (67% vs. 33% of complications). Conclusions: TLE during device upgrade is effective and does not attribute a disproportionate risk to the upgrade procedure.

Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantations remain limited. This study aimed to evaluate a standardized DOAC management regime consisting of interruption of a single dose prior to implantation and reinitiation within 6-24 h; also, patient clinical characteristics associated with this approach were identified. Consecutive patients undergoing standard TPS implantation procedures from two Swiss tertiary centers were included. DOAC peri-operative management included the standardized approach (Group 1A) or other approaches (Group 1B). Three hundred and ninety-two pts (mean age 81.4 ± 7.3 years, 66.3% male, left ventricular ejection fraction 55.5 ± 9.6%) underwent TPS implantation. Two hundred and eighty-two pts (71.9%) were under anticoagulation therapy; 192 pts were treated with DOAC; 90 pts were under vitamin-K antagonist. Patients treated with DOAC less often had structural heart disease, diabetes mellitus, and advanced renal failure. The rate of major peri-procedural complications did not differ between groups 1A (n = 115) and 1B (n = 77) (2.6% and 3.8%, p = 0.685). Compared to 1B, 1A patients were implanted with TPS for slow ventricular rate atrial fibrillation (AF) (p = 0.002), in a better overall clinical status, and implanted electively (<0.001). Standardized peri-procedural DOAC management was more often implemented for elective TPS procedures and did not seem to increase bleeding or thromboembolic adverse events.

Treatment of malignant epithelial thymic tumours, including thymoma and thymic carcinoma, is based on surgical resection, whenever possible. Mainstay of surgical treatment is complete resection with clear margins. This may require resection of adjacent structures, even major vessels. We describe a case of resection of the main pulmonary artery trunk and reconstruction with cadaveric homograft after induction chemo-radiotherapy for a locally advanced thymic carcinoma. Written informed consent was obtained from the patient.