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A chronic ulcer is usually defined as an injury that does not spontaneously evolve towards healing and does not progress through normal healing stages such as inflammation, proliferation and remodelling. This study was designed in order to compare two types of collagenases with mechanical debridement alone. It was thus possible to evaluate their differences in terms of pain and debridement efficacy. Patients were divided into three groups: 30 patients were daily dressed using an ointment based on collagenase produced by Vibrio alginolyticus (B group), 30 patients were daily dressed using an ointment based on a collagenase preparation derived from Clostridium histolyticum (N group) and 30 patients underwent classical mechanical debridement (M group). Complete wound healing over a period of 8 weeks occurred in 24 patients (27%) out of 90;10 patients belonging to the B group, 8 patients to the N group and 6 patients to the M group. This study was performed in order to highlight the differences between two commercially available collagenase-based ointments in comparison with mechanical debridement alone. At the final time point of week, the difference in the percentage of debridement was not statistically significant in all groups, but at 4 weeks, the debrided area in the B group was larger with respect to the N and M groups, suggesting a more rapid wound bed cleansing process. On the basis of our experience, collagenase derived from V. alginolyticus with hyaluronic acid showed chemical and physical properties that make it a product of great manageability and ensure the protection of peri-wound skin. Moreover, less pain was experienced by the patients. [ABSTRACT FROM AUTHOR]

Introduction Amelanotic Melanoma is a rare entity (2-8% of melanomas), its diagnosis is difficult, due to its pleomorphism and to the impossibility to make use of dermoscopy. These features imply a delay in diagnosis so that often these lesions are detected already in a metastatic stage. This delay leads to worse prognosis. Clinical case In our report we describe the case of a patient affected by a metastatic amelanotic melanoma without evidence of a primary lesion (Tx). The metastatic tumor was first diagnosed in 2003 after a parotidectomy and a concomitant lymphadenectomy. The patient underwent a bilateral neck dissection, hepatectomy, extended lymphadenectomy and thyroidectomy. Discussion The prognostic factors in melanoma are: stage, presence of ulceration, type of surgical intervention, depth of invasion and the localization of the primary tumor. Our patient presented a bad prognosis for all these features. In addition, the metastatic lesions found in our patient were localized in uncommon sites such as palatine tonsil, thyroid and parotid. The other localizations were quite common( bowel, liver). Conclusion Although the characteristics of the melanoma case in our patient indicated bad prognosis, the patient had a long survival (7 years). [ABSTRACT FROM AUTHOR]

Aim: Congenital genitalia anomalies are a spectrum of malformation, difficult to classify because similar or identical phenotypes could have several different aetiology; therefore it's essential to assess an efficient diagnostic algorithm for a quick diagnosis and to develop an efficient therapeutic strategy. The aim of this study is to underline the importance of imaging in case of ambiguous genitalia due to its high sensitivity and specificity in detecting internal organs and urogenital anatomy., Material of Study: We report a case of a young girl affected by a complex genitor-urinary malformation with an initial wrong anamnesis that led to a tricky diagnosis., Results: Imaging techniques - especially Magnetic Resonance Imaging (MRI) - together with karyotype, hormones and physical investigations, offered complete and reliable informations for the best surgical treatment of our patient., Conclusion: Karyotype, hormones investigation, and radiological examinations are the main criteria considered in the diagnostic iter. Ultrasonography (US) is the primary modality for the detection of the presence or absence of gonads and müllerian derivatives, whereas Cystourethrography can define urethral and vaginal tract or the presence of fistulas. In our experience MRI, due to its multiplanar capability and superior soft tissue characterization, proved to be useful to provide detailed anatomic information.

A 15 years-old patient was brought to our attention in June 2010 with a complex genito-urinary malformation: fusion of the labia majora and a partial union of labia minora, common urinary and vaginal meatus and clitoromegaly. The patient had a normal sexual feminine hormonal development. After diagnostic iter the patient underwent surgery twice. No signs of hormonal deficency was shown authorizing us to approach the disease as a congenital malformation due to an abnormality of intrauterine development. So surgical treatment was carried out, considering it as the gold standard for this type of malformations. It's considerable to emphasize that the association between clitoromegaly and fusion of the lower third of the urethra with the vagina has not been previously reported in the literature.

Pyoderma gangrenosum (PG) is a chronic skin disease with an incidence of 3-10 per million, and it is often associated with underlying systemic disease. A case of PG of the left leg successfully treated with local debridement and advanced and compression dressings, without systemic treatment is reported. Progression and healing of the ulcer was incredibly rapid. The treatment of PG usually consists of systemic administration of corticosteroids. But wherever the administration of systemic immunosuppressive therapy is impractical, a topical treatment can be used. This type of treatment does not represent a mere palliative, but could be significant for healing, as in the case of our patient.

Aim: Nonmelanoma skin cancer (NMSC) is the most common cancer in the world with an incidence 18-20 times greater than that of malignant melanoma. Basal cell carcinoma, which probably arises from immature pluripotential cells, is the most common malignant tumor of the skin in Caucasian. It occurs mostly on sun-exposed areas such as neck and face. MATERIAL OR STUDY: We performed a retrospective study of 327 consecutive patients, diagnosed for metatypical basal cell carcinoma. Tumors were analyzed and measured from the surgeon, excision margins were marked on the basis of palpable or visual alteration of the burden. The minimum surgical margin was equal to the short axis of the ellipse. Therapy was made according to guidelines., Results: A relevant difference came out between two genders. 213 Males (65%) were affected in comparison with only 114 females (35%). Concerning areas affected, first is cervico-facial area with a prevalence of 220 cases (67.3%), second trunk 33 cases (10.1%), third other areas 29 cases (8.86%), fourth limbs 32 cases (9.80%), fifth scalp with 13 cases (4%)., Discussion and Conclusions: Diagnosis is based on histological analysis. Histologically MTC is divided into two subtypes: intermediated and mixed. In the intermediate form transitional zones and tumor islets are found together, thus combining features of BCC and SCC In mixed subtype typical basal cells coexist with areas of conglomerated squamous cells, squamous pearls could be present.

Introduction: Metatypical cell carcinoma is a quite rare malignancy (5% of all non melanoma skin cancers), with features of basal cell carcinoma and squamous cell carcinoma. It is described as coexistence of basal cell carcinoma and squamous cell carcinoma with no transition zone between them., Materials and Methods: We performed a retrospective study of 327 consecutive patients, diagnosed for metatypical carcinoma. Statistical analysis was made to determinate most affected areas, gender prevalence, average age, presence of ulceration and infiltration, peripheral clearance rate., Results: A relevant difference came out between two genders. Chi-square test emphasized a relation between females and the presence of carcinoma on the scalp. In addition a strong correlation between mixed subtype and ulceration was evident. A strong relation between intermediate subtype and positive surgical margin was found; this data could identify a more aggressive behavior of intermediate type., Discussion: Differently from melanoma that usually arises on sun exposed areas, no relation was found between sun exposion and this tumor. This characteristic stresses on the importance of other risks factor apart from sun exposition., Conclusions: We identify some correlation between our data that cannot be explained with previous interpretation of sun exposition.

Introduction: 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., Case Report: 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., Discussion: 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., Conclusions: This report highlights that leiomyoma, even of large dimension, must be included in the differential diagnosis of painful, subcutaneous masses.

Introduction: Incisional hernias can be treated with laparoscopic and laparotomic surgery. Laparoscopic surgery can be made without the use of mesh when performing component separation technique. This technique allows to limit the adverse effects to foreign body and promotes a tension-free closure. We studied intravescical pressure changes during intervention in order to quantify intrabdominal pressure., Material and Methods: A prospective, non-controlled study (cohort study), was made on thirty patients, treated to repair incisional hernia. Standard panniculectomies and component separation technique were performed in all patients. A standard Foley catheter was inserted in to the bladder in order to measure pressure modification in the peri-/postoperative phases. Statistical significance of modifications of pressure values was evaluated with the Wilcoxon's sum rank test., Results: Bladder pressure increased after hernia repair and skin closure and decreased in the first day after surgery, but without returning to the original values, and these modifications were statistically significant., Discussion: We study intravescical pressure changes as an indirect measurement of intrabdominal pressure. Intrabdominal pressure cut-off for the rise of complications is 20 mmHg. This technique allows to maintain pressure under dangerous limits and to limits complications.