Biochar as Alternative Material for Heavy Metal Adsorption from Groundwaters: Lab-Scale (Column) Experiment Review.

The purpose of this manuscript is to present a review of laboratory experiments (including methodology and results) that use biochar, a specific carbon obtained by a pyrolysis process from different feedstocks, as an alternative material for heavy metal adsorption from groundwater. In recent years, many studies have been conducted regarding the application of innovative materials to water decontamination to develop a more sustainable approach to remediation processes. The use of biochar for groundwater remediation has particularly attracted the interest of researchers because it permits the reuse of materials that would be otherwise disposed of, in accordance with circular economy, and reduces the generation of greenhouse gases if compared to the use of virgin materials. A review of the different approaches and results reported in the current literature could be useful because when applying remediation technologies at the field scale, a preliminary phase in which the suitability of the adsorbent is evaluated at the lab scale is often necessary. This paper is therefore organised with a short description of the involved metals and of the biochar production and composition. A comprehensive analysis of the current knowledge related to the use of biochar in groundwater remediation at the laboratory scale to obtain the characteristic parameters of the process that are necessary for the upscaling of the technology at the field scale is also presented. An overview of the results achieved using different experimental conditions, such as the chemical properties and dosage of biochar as well as heavy metal concentrations with their different values of pH, is reported. At the end, numerical studies useful for the interpretation of the experiment results are introduced.

Pityriasis versicolor during anti-TNF-α monoclonal antibody therapy: therapeutic considerations.

Anecdotal reports have shown that tumour necrosis factor (TNF)-α inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti-TNF-α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re-evaluated. In patients non-responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week(-1) for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti-TNF-α therapy is seldom reported, it is not likely to be rare, but rather under-reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

Necrotizing vasculitis in a patient affected by autoimmune hyperthyroidism treated with propylthiouracil.

Necrotizing vasculitis is a complex phenomenon because of an inflammation of small and larger vessels with polymorph infiltration within the vessel walls and leukocytoclasis, occurring in several autoimmune diseases. Propylthiouracil (PTU) is a medication commonly used to treat hyperthyroidism, but it is associated with various rare side effects, such as antineutrophil cytoplasm antibody-positive vasculitis. In the last decades, multiple cases of PTU causing antineutrophilic cytoplasmic antibody have been reported, some of them fatal. The present authors report the case of a 34-year-old Caucasian female affected by autoimmune hyperthyroidism treated with PTU, presenting an antineutrophil cytoplasm antibody-positive necrotizing vasculitis, with high levels of anticardiolipin antibodies that involved the upper arms and buttocks. The clinical manifestations improved after discontinuing of PTU and immunosuppressant treatment.

Efalizumab-associated papular psoriasis: an adverse reaction to efalizumab in three cases.

Efalizumab-associated papular psoriasis is a common adverse event caused by efelizumab therapy. This clinical manifestation is characterized by a transient popular eruption localized especially on the flexural areas and on the back. We report three cases of efalizumab-associated papular psoriasis.

Lentigines within nevus depigmentosus: a rare collateral effect of UVB therapy?

Nevus depigmentosus is an uncommon hypopigmented macule or patch that is congenital and stable in its relative size and distribution throughout life; it occurs sporadically and may be localized, segmental or, less often, systematized. We report the case of a 17-year-old girl with a segmental achromic nevus of the left leg and a patch on the lower back with late age of onset who developed lentigines after prolonged intense ultraviolet B exposure as a consequence of an incorrect diagnosis of segmental vitiligo.

Two cases of Zoon's balanitis treated with pimecrolimus 1% cream.

BACKGROUND: Plasma cell balanitis is a disorder of the middle-aged and older uncircumcised male. Several treatments have been proposed to treat this disease, but plasma cell balanitis is often resistant to conventional therapy. METHODS: We decided to evaluate the efficacy and tolerability of pimecrolimus 1% cream in resistant Zoon's balanitis. We report two cases of resistant Zoon's balanitis treated with topical pimecrolimus 1% cream. RESULTS: One of the two patients had a complete regression of the lesion after 2 months of therapy. The other one had a great improvement of the lesion, but a hyperpigmented patch persisted on the glans. CONCLUSION: Pimecrolimus 1% cream may be a valuable second-line treatment for patients with steroid related side effects or with steroid and other conventional therapy resistant Zoon's balanitis, as well as for those rejecting circumcision.

Treatment of refractory pemphigus vulgaris with anti-CD20 monoclonal antibody (rituximab): five cases.

BACKGROUND: Pemphigus vulgaris is an autoimmune disease characterized by blisters and widespread erosions, involving skin and mucous membranes, caused by autoantibodies to desmoglein 1 and 3. This pathology is associated with increased morbidity and mortality if untreated. The treatment of pemphigus vulgaris requires multiple immunosuppressive agents, but often it is particularly resistant. OBJECTIVE: To evaluate the efficacy and safety of rituximab therapy in refractory pemphigus vulgaris. METHODS: Five patients diagnosed as having pemphigus vulgaris were treated with anti-CD20 monoclonal antibody (rituximab). Each patient was treated with rituximab intravenously at a dosage of 375 mg per square metre of body surface area once weekly for 4 weeks. RESULTS: All the patients presented clinical resolution. No adverse effects were observed. It is important to observe the clinical evolution in the future, but our experience is still limited to a short lifetime and follow-up. CONCLUSION: In our experience rituximab has been an effective and safe treatment for refractory pemphigus vulgaris.

Cutaneous granulomatous reaction to injectable hyaluronic acid gel: another case.

We report a case of a granulomatous reaction in the melolabial folds, occurring 10 days after treatment with Restylane. The patient, who had previously been treated with the same product in the last 2 years without any adverse effect, developed an unusual early fibrotic reaction that we hypothesized related to hypersensitivity after repeated use. The lesions slowly disappeared with topical steroid therapy. An improved knowledge of the modality of these uncommon adverse effects is necessary to assess the long-term safety and efficacy of this product.

Onychomatricoma: first description in a child.

Onychomatricoma is an uncommon benign tumor of the nail matrix, with peculiar clinical and histologic features and electron microscopic findings. The main clinical signs are longitudinal ridging, yellow coloration along the entire length of the nail plate with splinter hemorrhages in its proximal portion, and a tendency towards transverse overcurvature of the affected nails. We report onychomatricoma associated with onychomycosis in the same nail in a 4-year-old girl.

Congenital pseudoclubbing of a fingernail caused by subungual hemangioma.

BACKGROUND: Nail dystrophies in newborns are rare and are particularly frightening when they appear as masses involving a single digit, suggesting the possibility of a tumor. OBJECTIVE: The aim of this study is to report 3 infants with a congenital pseudoclubbing appearance of a digit and with a reddish discoloration caused by the presence of a subungual hemangioma. METHODS: Diagnosis was based on clinical examination and ultrasonography. RESULTS: Clinical presentation and vitrocompression showed the presence of a vascular mass. Ultrasonography confirmed the diagnosis of a subungual hemangioma. The lesions showed a spontaneous regression on follow-up. CONCLUSION: Localization of hemangioma under the proximal nailfold is extremely rare and produces nail pseudoclubbing caused by capillary vessel proliferation in the soft tissue of the subungual region, which is associated with a reddish discoloration of the nail that typically fades with compression. Hemangiomas of infancy located in the proximal nailfold are rare, and, in our opinion, not at risk to become big masses with tissue damage and compression.

Drug-induced nail abnormalities.

A large number of drugs may be responsible for the development of nail changes, including cancer chemotherapeutic agents and retinoids, however, only a few classes of drugs are consistently associated with nail symptoms. Drug-induced nail abnormalities result from toxicity to the matrix, the nail bed, the periungual tissues or the digit blood vessels. The most common symptoms include Beau's lines, onychomadesis, melanonychia, onycholysis and periungual pyogenic granulomas. Drug-induced nail changes usually involve several or all of the nails. In most cases, nail abnormalities are asymptomatic, but can sometimes cause pain and impair manual activities.