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Most ulcers occur with slough and need debridement treatment. Surgical treatment is usually performed but many patients need an additional chemical therapy to promote healing process. This type of wound bed preparation is slower than surgical one, but it is essential in those patients who are not eligible for surgery because of systemic diseases. A collagenase derived from the bacterium Clostridium hisolyticum is the most used.To evaluate the safety and the effectiveness of a new collagenase produced by Vibrio algynoliticum.Forty patients were enrolled and daily treated for five weeks with Bionect Start® ointment. Parameters took into account were fibrin degradation and pain relief. The same team carried out treatment during the study period of five weeks.32 patients achieved a relevant reduction of the ulcer size, an improvement of the wound bed and a reduction of fibrin and exudates. Among of 32, 14 patients presented with a complete healing. Eight patients had mild or no improvements. The patients referred a remarkable pain reduction, 20 out of 40 patients reported a decrease in pain during treatment, 16 patients referred no pain at all and four patients had no significant changes.The application of this product on the lesions promotes vascularized granulation tissue and reduces formation of fibrin and exudate. Furthermore, a macroscopical margins proliferation is highlighted after a short time and an improvement of periwound skin is observed during the treatment period. Bionect Start® allowed easy removal of dressing, less pain for patient, reduction of dressing time.

Investigate if the tyrosinase mRNA expression may be predictive of the outcome on ultra-thin, thin, and thick melanoma patients.In our study, we sought to correlate tyrosinase mRNA expression to the outcome in a group of 71 patients with thick, thin and ultra-thin melanomas.71 patients with melanomas underwent a SLNB (sentinel lymph node biopsy) at the "Sapienza" University of Rome. Among these, 38 patients had thin melanomas, while the other 33 patients had thick melanomas. In every patient's sample histology, immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) was completed. We then correlated tyrosinase mRNA expression to the statistical analysis of the outcome of patients.Positivity of histology was found in one patient (1.4%), immunohistochemistry in five patients (7%), and tyrosinase in 52/71 (73.2%). Thickness and tyrosinase positivity were predictive for disease progression (p0.05). The median follow-up was 58.24 months. There were recurrences and/or deaths in both groups of patients.Nodal metastasis in melanoma is uncommon, especially in patients with thin melanomas. In this study, histology and immunohistochemistry were found to be non predictive for the risk of nodal metastases, while instead, tyrosinase m-RNA expression appeared to play a role in highlighting those patients with a risk of disease progression. Moreover, no differences among the thin melanoma groups of patients (0.30-0.75 mm and 0.76-1.00 mm) were observed.

The objective of this study was to compare the efficacy and effectiveness between an analgesic combination of tramadol/paracetamol (37.5+325 mg), and paracetamol monotherapy (1000 mg) for acute postoperative pain after hand and foot surgery. The study design was a single blind randomized controlled trial. A total of 114 patients who underwent hand and foot surgery under brachial plexus block were randomized to receive either paracetamol monotherapy (group P, n=57) or tramadol/paracetamol (group TP, n=57) postoperatively. The number of patients who required an extra-dose of analgesic pain score, and adverse affects were compared between the two groups. Analgesic requirement was significantly lower in those in the TP group when compared with the P group. In the TP group, the pain score after surgery was significantly lower than in the P group. Adverse effects did not significantly differ between the two groups. There were no serious adverse events in either group. The association of tramadol and paracetamol appears to have more efficacy when compared with paracetamol monotherapy for acute postoperative pain after hand and foot surgery.

Palliative tendon transfer procedures for radial nerve palsy are continuing to evolve. This paper reports outcomes of 10 patients with isolated and traumatic radial nerve palsy underwent "minimal transfer". All patients improved functionally and could attend their routine activities. The flexor carpi ulnaris and palmaris longus tendon transfer has some advantages in terms of simplicity, shorter operative time, less morbidity, better wrist and finger extension and thumb extension and abduction.

Scaphoid fractures detected in the subacute stage require a more meticulous and prompt approach to prevent chronicity and regain wrist function. Oblique-type scaphoid fractures are potentially unstable and may result in detrimental sequelae. Aim of this study is to suggest an easy surgical approach to restoration of the oblique-type scaphoid fractures or nonunions by using of a customized mini-plate, italic-S shaped. This surgical intervention is associated with promising outcomes and at long-term follow-up showed to avoid the development of a carpal collapse with concomitant arthritis of the radiocarpal joint.

Vascular leiomyoma is a rare tumour of smooth muscle origin. It has been reported in many anatomical sites, but it usually affects limbs. It's recurrence rate is slow but it's quite difficult to make diagnosis.The study describes the case of a 53-year-old man, with a subcutaneous, large vascular leiomyoma of the right clavicular region. The patient had a painful, slow-growing mass, measuring more than 20 mm. The mass had a relatively homogeneous, hypoechoic-echo texture, with a small amount of posterior acoustic enhancement. No diagnosis was made and the patient underwent surgery for a suspected leyomioma. After surgery a hard, round-shaped tumor, measuring approximately 43 x 32 mm of diameter was found with histological features of leyomioma.The case has an unusual clinical presentation, for the uncommon localization and size of the mass. US imaging and histopathologic features are reported. The rarity of vascular leiomyoma makes diagnosis difficult and frequently delayed. Differential diagnosis includes infected sebaceous cysts, glomus tumors, hemangiomas, angiolipomas, ganglions, and traumatic neuromas.This report highlights that leiomyoma, even of large dimension, must be included in the differential diagnosis of painful, subcutaneous masses.