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Speckled lentiginous nevus is a congenital freckled nevus on which melanocytic nevi arise more frequently than on healthy skin. Its borders with respect to congenital melanocytic nevus are not always clear-cut and the possible onset of melanoma is a dreaded complication in both disorders. This complication should be suspected in the presence of a swelling that arises in the context of a congenital malanocytic nevus and its removal, which seeks to clarify its nature, is mandatory. Since congenital melanocytic nevi are often associated with hypertrichosis, it can happen that around a pilosebaceous follicle inflammatory granulomas, which can simulate a melanoma, are formed with various types of mechanisms. The current work describes the case of a granuloma formed around hair fragments in a giant speckled lentiginous nevus in a 13-year-old boy. [ABSTRACT FROM AUTHOR]

Myofibroma is a rare benign tumor of myofibroblasts. The pediatric dermatologist may clinically suspect that it is not the much more frequent deep infantile hemangioma and must perform a biopsy, because only histological examination can easily clarify the diagnosis and differentiate it from other rare benign and malignant neoplasms of the newborn. Congenital myofibroma (CM) of the skin is most often isolated, but can present multiple cutaneous elements or also affect other organs, especially bones, central nervous system and lung. CM has a usually benign prognosis and tends to regress spontaneously, as can be seen when it is not completely removed and in multicentric forms. A case was described in a one-month-old baby girl and the clinical differential diagnosis from infantile hemangioma was discussed. [ABSTRACT FROM AUTHOR]

Organ malperfusion is a serious complication of acute aortic dissection type A. Increased awareness of this complication and the availability of better diagnostic tools may improve the survival rate for these patients. Here, we discuss the potential role of laparoscopy in the setting of an acute dissecting aneurysm complicated by mesenteric ischemia.

Gastrointestinal stromal tumours are rare neoplasms originating from the connective tissue of the digestive tract and constitute most of the non-epithelial primitive digestive tumours. The origin from the interstitial cell of Cajal is appreciated because of this tumours constantly present the expression of the surface antigens CD34 and CD 117 which can be determined immunohistochemistry. In the majority of cases, GISTs are symptomatic and symptoms are most commonly related to mass effect or bleeding. Asymptomatic GISTs are often found incidentally on physical examination, radiologic imaging, endoscopy, laparotomy or laparoscopy. US endoscopy and fine needle aspiration with subsequent immunohistochemistry analysis afford the best diagnostic accuracy. In primary and localized GISTs surgery is always indicated and laparoscopic technique is feasible and is recommended as the treatment of choice for all the patients. Imatinib should be started in metastatic or recurrent disease and neoadjuvant imatinib is also experimental, although its use may be justified in unresectable or marginally resectable GIST. Sunitinib has recently been approved for patients with GIST principally those who fail imatinib therapy. Our experience is based on the study of 7 GISTs: only in 2 cases the neoplasm was found occasionally; in the other, symptoms were related to mass effect or bleeding. Laparoscopic tumour resection was then performed in all the patients. The definitive diagnosis of gastrointestinal stromal tumour, was made postoperatively by analysis of the histopathological and immunohistochemical findings. We confirmed constant high positivity for CD34 and for CD117. Even in the absence of unfavourable prognostic indicators, all patients are regularly followed-up.

The authors report a rare case of acute onset of ileal non-Hodgkin's lymphoma with acute abdomen due to bowel perforation. The patient, a man aged 36 years, had been HIV-positive for more than 15 years. The patient had been on continuous, differentiated pharmacological treatment for the previous 5 years, and in the last month had had repeated episodes of fever with no clear aetiopathogenesis. Physical examination yielded negative findings and abdominal and chest CT failed to reveal any obvious lesions. The patient was admitted as an emergency case with a picture of acute abdomen and was immediately operated on; ileal perforation due to multiple lymphomatous lesions in the small bowel was diagnosed. The histological diagnosis was large-cell non-Hodgkin's lymphoma type B. After the operation, the patient was treated by chemotherapy and, currently, after a 12-month follow-up, is in good general condition.

The aim of this study was to confirm the clinical efficacy of oxerutins by evaluation of venous parietal tone and microvascular perfusion in a double-blind, randomized, placebo-controlled study. The study included 60 patients. Venous tone was evaluated by air-plethysmography (APG) in patients with venous insufficiency (CVI). Forty patients were treated with oxerutins and 20 with placebo for 4 weeks. The dose of the first 2 weeks was higher than that of the following 2 weeks. The age range was between 18 and 65 years. Randomized patients received treatment (oxerutins or placebo) according to the grade of CVI. Patients with grade I CVI received 2 g/day in the first 2 weeks of treatment and 1 g/day in the following weeks. Patients with grade II CVI received 3 g/day in the first 2 weeks and 2 g/day in the following 2 weeks. Visits were scheduled at baseline time (visit 1), at 2 weeks (visit 2) and at 4 weeks (visit 3). They were assessed with the following: (1) APG; (2) light reflection rheography (LRR); (3) capillaroscopy; (4) liquid crystals thermography. CVI signs/symptoms--heavy legs, edema, paresthesia, and cramps--were evaluated following a 4-point rating scale (0 = no symptom; 3 = severe symptoms). At visit 3 a final opinion on efficacy was provided by both patients and investigators, based on a 4-point scale (none, fairly good, good, excellent). The two groups were homogeneous for age, sex, and clinical distribution. The changes in venous capacity, were significant (p<0.01) in the oxerutins group at visits 2 and 3; values in the placebo group remained unchanged. The changes in LRR were significant in the treatment group at visits 2 (p<0.05) and 3 (p<0.01); values in the placebo group remained unchanged. Changes in temperature were significant in the oxerutins group at visits 2 (p<0.05) and 3 (p<0.01); changes in the placebo group were not significant at the end of the study. Capillaroscopy showed an improvement in patients treated with oxerutins. The results of the analysis of signs/symptoms favored active treatment. The overall effects of oxerutins were significantly better than the effects of placebo. Considering both noninvasive tests and clinical evaluation, oxerutins is effective in controlling chronic venous hypertension, without side effect, and with good tolerability.

Bleeding non-neoplastic lesions of the upper gastrointestinal tract, not due to portal hypertension, are a frequent cause of emergency admission. In the present paper we report our retrospective experience in hemostatic injection treatment of these lesions. From May 1990 to May 1994, 164 patients were admitted to our institution for a bleeding gastrointestinal lesion. In 124 cases an ulcer classified according Forrest's criteria was detected. Four patients underwent immediate surgery. The second group of 86 patients (FIIa/FIIb/FIII) were treated conservatively. The third group of 34 patients (FIa/FIb/FIIa) underwent perilesional injection of adrenaline 1:10,000 and polidocanol 1% saline solution during endoscopic examination; 29% (25 pts) of the second group re-bled during the first 72 h vs 8.8% (3 pts) of the third group. The postoperative morbidity in the rebleeding patients was higher in the second group: 38.4% vs 0%. The importance of immediate, inexpensive, and simple hemostatic treatment extended to Forrest IIa lesions is emphasized.

Skin and/or liver biopsy specimens were obtained from the following patients: 15 anti-hepatitis C virus (HCV), HCV RNA-positive patients and 3 anti-HCV, HCV RNA-negative patients with type II mixed cryoglobulinemia (MC); 7 anti-HCV, HCV RNA-positive patients with chronic active liver disease (CALD); 5 anti-HCV, HCV RNA-negative patients with noncryoglobulinemic vasculitis; and 7 anti-HCV, HCV RNA-negative patients with lichen ruber planus. A pool of murine monoclonal antibodies (MAbs) developed against c22-3, c33c, and c100-3 proteins was used to detect HCV-related antigens (Ags) by indirect immunohistochemistry. Acid electroelution (AEE) of tissue sections was performed to enhance the sensitivity of the immunohistochemical method. In anti-HCV-positive MC patients, specific HCV-related Ags were detected in the small vessels of the skin and in the cytoplasm of hepatocytes. Prior AEE of biopsy sections allowed detection of HCV Ags in 6 of 15 (40%) skin biopsy and in 9 of 14 (64.3%) liver biopsy specimens. HCV immunoreactive deposits in the skin displayed two immunohistochemical patterns: (1) coarse intraluminal material associated with dermal inflammatory infiltrates and intravascular deposition of eosinophilic hyaline material; and (2) reactivity confined to the vessel wall in the context of an apparently normal tissue. Immunoglobulin (Ig) G and IgM deposition in the skin showed immunohistochemical features comparable with those found for HCV Ag deposits.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Classical Kaposi's sarcoma (KS) is a sporadic disease that is particularly prevalent in Mediterranean countries., Objective: The aim of the study was to update clinical information about this rare condition., Methods: A survey of 163 cases observed in the period 1971-1990 in Bari, South Italy, was carried out. All records were reviewed and, when lost to follow-up for more than 6 months, patients were called back to update personal and family histories. The age at onset averaged 64 years (range 18-85). The male-to-female ratio was 3:1. No familiar occurrence was identified, and no significant association was found with other conditions (i.e. second primary malignancies and diabetes mellitus). Death from KS occurred in 16 cases, at the mean age of 71 years, an average of 5.7 years after the onset of the disease. To assess whether the different clinical patterns of the disease in its earlier stages may give any indication of its subsequent clinical course, all cases were re-classified into three groups (low-, moderate- and high-eruptivity group) on the basis of both the extent and the rate of spread of the disease before first admission; group-stratified survival function was evaluated using Kaplan-Meier's life table method., Results: Highly significant (p < 0.0001) differences were found in survival profiles of the three study groups, also when only deaths due to KS were computed., Conclusion: These findings provide some support to the hypothesis that three subsets of classical KS exist that have different prognoses and, consequently, need different therapeutic approaches.

Psoriatic lesions are relatively frequent in patients with chronic liver disease. Furthermore, therapy with interferons tends to exacerbate the symptoms. The pathogenesis of psoriatic lesions is unclear. An important question is whether such lesions may be linked to the underlying chronic liver disease in these patients, or whether they are incidental manifestations of psoriasis vulgaris. We collected biopsy specimens from involved and uninvolved skin areas of chronic liver disease patients with psoriatic manifestations, as well as from psoriasis vulgaris patients, and investigated the patterns of integrin adhesion receptors by means of immunohistochemical methods. Integrin expression is known to be characteristically altered in psoriasis vulgaris. We found some of these changes in chronic liver disease psoriatic lesions-namely pericellular redistribution and suprabasal expression of the basement membrane receptor alpha 6 beta 4 and of the intercellular integrins alpha 2 beta 1 and alpha 3 beta 1. However, psoriasis vulgaris causes two other typical changes: One is the induction of the prototype fibronectin receptor alpha 5 beta 1, and the other is the alteration of integrin expression in areas of the epidermis that are macroscopically normal. These two changes were not found in chronic liver disease psoriasis biopsy specimens in 14 patients investigated. Thus integrin expression may be useful in differentiating chronic liver disease psoriatic lesions from psoriasis vulgaris lesions. Even though the two types of lesions are indistinguishable on inspection or by their histological features, they may be caused by distinct pathogenetic mechanisms. It remains to be seen whether the underlying chronic liver disease has a role, albeit indirect, in such mechanisms.

In the above double-blind multicenter study the efficacy and tolerability of 50 and 100 mg doses of fluconazole were compared with 100 mg itraconazole in 178 patients with T. corporis, T. cruris, and T. pedis infections. All patients were submitted to clinical and mycological examination before starting, at weekly intervals during treatment, and 4 and 8 weeks after its conclusion. Duration of the three therapeutic regimes was 15 days for T. corporis and T. cruris, and 30 days for T. pedis infection. The percentage of symptomatic cure was 85% and 86.5%, respectively for 50 and 100 mg fluconazole, and 83% for itraconazole. Mycologic cure was achieved in 81.4% of patients treated with 50 mg fluconazole, 83.3% in those treated with 100 mg fluconazole, and 67.9% in those treated with 100 mg itraconazole. None of the groups showed changes in laboratory parameters. It is concluded that all three treatment schemes had high antimycotic activity, but fluconazole both 50 and 100 mg daily was superior. Both drugs were well tolerated and compliance was good.

Background: A number of experimental studies have substantiated changes in angiogenesis and in laminin/laminin-receptor interactions during tumorigenesis and tumor progression. However, these observations have never been verified objectively in tissues from a well-defined model of tumor progression., Methods: Tissues from 97 proliferative lesions of the melanocyte lineage defining distinct steps in tumor progression were investigated immunohistochemically for changes in angiogenesis and expression of the laminin receptor (67-kilodalton molecule)., Results: Although the microvessel number was low in common nevi, it increased significantly in nevi with architectural disorder with varying degrees of melanocytic atypia (termed "nevi with ADMA"), and these changes persisted during transformation. Progression to primary melanomas was accompanied by a high microvessel number and progression to metastases by another significant increase. The number and diameter of microvessels were significantly higher at the lesion base than at the adjacent dermis of primary melanomas and higher in the lesion than in the adjacent tissue of metastatic foci. Expression of the laminin receptor, evaluated as percentages of positive lesions and positive cells per lesion, underwent upregulation in the course of progression. Changes in expression were associated mostly with nevi with ADMA, transformation, and deepening of the tumors into the dermis., Conclusions: These in situ data suggest that more frequent interactions between melanocytic cells and their microvasculature via adhesion protein laminin occur during tumor progression.

A family is described in which two sibs of a consanguineous marriage have alopecia, convulsions, EEG anomalies and mental retardation. Although the children have significant features resembling those described by Moynahan, this syndrome appears to be different in the mode of inheritance and in other aspects (sensorineural hearing loss in the male, syndactyly in the female).

T cell subsets (theophylline-sensitive T lymphocytes and T gamma lymphocytes), and the activity of soluble immune response suppressor (SIRS) factor have been investigated in a total of 53 patients with squamous cell carcinoma (SCC) of the skin. Eight of these had metastatic regional lymph nodes. The results showed decreased values for theophylline-sensitive T lymphocytes and elevated values for T gamma cells. Suppressor function evaluated by means of SIRS factor was normal in 36 patients with non-metastatic skin SCC and decreased in 8 with metastatic skin cancer.

A series of 14 cases of sporotrichosis cutanea is reported. Epidemiological and clinical aspects of the disease are discussed in the light of recent data. In addition to cultures, the diagnostic methods to be considered include an indirect immunofluorescence test, which is positive at variable titre and for which use may be made of normal human antiserum or anti-immunoglobulin, mainly IgG and IgM, antisera. The mainstay of the treatment is preparations of iodine, with trimethoprim- sulpha-methoxazole as a possible alternative.

Fifty seven patients over 65 affected with cholelithiasis underwent surgical procedures at II Patologia Chirurgica-University of Bari-Italy, from July 1987 to December 1988. Different risk factors were considered. The results, which reported a low incidence of morbidity and mortality, suggest the importance to adopt early surgery. Though 73.2% of patients had associated pathologies and 28.6% had two or more risk factors, only 5.3% of them had complications not strictly related to surgery.

Twenty-two non-ulcerated basal cell carcinomas and 30 non-ulcerated squamous cell carcinomas were selected to study the reactive cellular infiltrate, utilizing histological, histoenzymatic and immunological methods. Substantial differences in cell behaviour were observed between the two tumors: advanced and metastatic squamous cell carcinoma showed prominent presence of T8+ lymphocytes, Leu 7+ cells, macrophages, mast cells and granulocytes, notably eosinophils. Degranulation of mast cells was seen both in the tumor itself and in the adjacent stroma. The basal cell carcinoma presented a low count of T4+, T8+ lymphocytes, whereas Leu 7+ cells and granulocytes were absent.

The authors report the results of the lymphographic examinations performed on 123 patients affected with melanoma of the limbs. The patients were divided into 2 groups according to the different clinical stages; they all had pathologic confirmation. The following lymphographic parameters were considered: sensitivity, specificity, efficacy and positive/negative predictive value. The results obtained in the first group of patients (clinical stage: I) demonstrated lymphography to have low sensitivity, specificity and efficacy in the staging of melanomas (37%, 50% and 45%, respectively). On the contrary, lymphography could be trusted in the study of stage II melanomas thanks to its high sensitivity. As for stage III, the methodology had a clinical indication only in the follow-up of melanomas treated with radiochemotherapy.

Fourteen patients, affected with hepatic echinococcosis, who underwent total pericystectomy at II Patologia Chirurgica, University of Bari-Italy, were retrospectively evaluated. The period considered was July 1987-December 1988. Immediate (low morbidity and no mortality) and late (no recurrences) results showed that total pericystectomy is the treatment of choice in hepatic hydatidosis.