'Animal-type' melanoma of the scalp with satellitosis and positive sentinel nodes in a 4-year-old child: case report and review of the literature.

BACKGROUND: Although showing a rapidly rising incidence, paediatric melanoma is relatively rare, accounting for 1-4% of all cases of melanoma and for 1-3% of all paediatric malignancies. The overall survival rate in paediatric patients seems to be similar to that recorded in adults. 'Animal-type' melanoma (ATM) is a rare melanoma subtype, occurring both in childhood and in adults, that shows a close histological resemblance to the heavily pigmented melanocytic tumours observed in grey and white horses. CASE PRESENTATION: We present a case of ATM of the scalp with satellitosis and two positive sentinel nodes in a 4-year-old male child. No other tumour deposits were found in the subsequent regional lymphadenectomy; the patient has been tumour free for 30 months. CONCLUSIONS: We treated our case of ATM in a child as the other types of paediatric melanoma, therefore as an adult melanoma. ATM is generally considered a neoplasm with an indolent course, that occasionally shows an aggressive behaviour, and patient deaths of ATM have been reported. Due to the rarity of ATM, further studies are needed to better define the biological behaviour of this particular melanoma subtype and the therapeutic and follow-up strategies.

[Scavenging effect of lazaroids U78517F, U74389F, U74500A on oxygen free radicals produced by stimulated human polymorphonuclear leucocytes and by chemical method] / Effetto scavenger dei lazaroidi U78517F, U74389F, U74500A sui radicali liberi dell'ossigeno prodotti da polimorfonucleati umani stimolati e mediante metodo chimico.

Authors investigated the scavenger capability of lazaroids, a new group of compounds (21-aminosteroid) that are reported in the literature to have interesting anti-lipid peroxidation properties. Authors tested the degree of scavenger activity related to the oxygen derived free radicals (ODFR) with different methods: 1) chemiluminescence; 2) production of superoxide anion from activated polymorphonuclear cells; 3) production of hydroxyl radical through a chemical procedure. Results showed a global scavenger activity of the three lazaroids (U78517F, U74389F, U74500A) in all the various tests, but differences of intensity of their action were noted among in each compound. We can thus attribute to these compounds a scavenger activity on the oxygen free radicals; this activity may facilitate their already known anti-lipid peroxidation action. Therefore, clinical use of lazaroids can be hypothesized for the diseases in which inflammation plays an important pathogenetic role via the production of oxygen free radicals and the resulting lipid peroxidation associated with tissue damage.

Temperature influence on stimulated PMN respiratory burst.

Body temperature can modulate the pathogenesis of infectious, metabolic and autoimmune diseases. This effect has been attributed to several hypothesized mechanisms. Body temperature could play an important role in influencing some cellular functions of human white blood cells. In this work we examined the temperature effect on the respiratory burst in human neutrophils. Human polymorphonuclear leucocytes (PMN) were obtained from heparinized venous blood by dextran sedimentation and erythrocyte lysis with NH4Cl (0.87%). Granulocytes were stimulated with opsonized zymosan (OZ), formyl-methionyl-leucyl-phenylalanine (FMLP), phorbol myristate acetate (PMA), and monosodium urate (MSU) crystals at different temperatures (26, 37, 39, 40, 42 degrees C). The technique of luminol dependent chemiluminescence (CL) was used as indicator of oxygen free radicals (OFR) release by stimulated cells. OFR production from PMN stimulated with OZ, PMA, FMLP was higher at 37 degrees C than at 26, 39, 40, 42 degrees C (p < 0.001 OZ stimulated PMN at 40-42 degrees C; p < 0.05 PMA stimulated PMN at 42 degrees C. Significantly different from 37 degrees C value). OFR release from PMN stimulated with MSU crystals was significantly increased at 39 degrees C compared to 37 degrees C value (p < 0.001). This effect could not only be attributed to temperature influence on neutrophil activity. The specific polymorphonuclear leukocyte response to the microcrystals and the temperature influence on chemical and physical characteristics of the crystals may play an important role. We are now studying the temperature effect on activity of PMN exposed to others crystals.

Vessel-wall recovery after diode laser-assisted microvascular anastomosis: clinical and histologic analysis on long-term follow-up.

The authors recently reported an experimental study on diode laser-assisted microvascular anastomosis (LAMA) in the femoral arteries and veins of rats. Good success rates and very promising histologic results obtained in this preliminary phase suggested an extension of the investigation with a larger number of rats and for longer follow-up periods. In the present work, they describe an experimental study with two main goals: 1) improvements of the laser-assisted surgical procedure for reduction in the number of permanent stay sutures, with minimization of bleeding at the end of the intervention, compared with conventional microvascular sutured anastomosis (CMSA); and 2) providing more information on the repair mechanism(s) induced by laser treatment, obtained from clinical and histologic analyses extended up to 3 months of follow-up. In a total of 64 Wistar rats, 46 arterial and 22 venous LAMAs were performed, and 15 arterial and 11 venous CMSAs. The recorded success rates of LAMA in both arteries and veins were fairly high (67/68 at the time of surgery, and 54/55 in the follow-up), and substantially comparable with those of CMSA. Clear evidence of a superior healing process in the LAMAs was provided by histologic examinations. In particular, specific stains and immunohistochemistry analysis indicated that laser irradiation can induce wide proliferation of smooth muscle cells and negligible scar tissue which, together with diminished foreign-body reaction consequent to the reduction of suture material, result in a better restoration of vessel structures.

Oxygen Radical Scavenger Activity, EPR, NMR, Molecular Mechanics and Extended-Hückel Molecular Orbital Investigation of the Bis(Piroxicam)Copper(II) Complex.

The oxygen radical scavenger activity (ORSA) of [Cu(II)(Pir)(2)] (HPir = Piroxicam = 4-hydroxy -2- methyl -N-2- pyridyl -2H- 1,2-benzothiazine -3- carboxamide 1,1-dioxide) was determined by chemiluminescence of samples obtained by mixing human neutrophils (from healthy subjects) and [Cu(II)(Pir)(2)(DMF)(2)] (DMF = N,N -dimethylformammide) in DMSO/GLY/PBS (2:1:2, v/v) solution (DMSO = dimethylsulfoxide, GLY = 1,2,3-propantriol, PBS = Dulbecco's buffer salt solution). The ratio of the residual radicals, for the HPir (1.02.10(-4)M) and [Cu(II)(Pir)(2)(DMF)(2)] (1.08.10(-5)M)/HPir (8.01.10-(-5)M) systems was higher than 12 (not stimulated) [excess of piroxicam was added (Cu/Pir molar ratio approximately 1:10) in order to have most of the metal complexed as bischelate]. In contrast, the ratio of residual radicals for the CuCl(2) (1.00.10(-5)M) and [Cu(II)(Pir)(2)(DMF)(2)] (1.08.10(-5)M)/Hpir (8.01.10(-5)M)system was 5. The [Cu(II)(Pir)(2)] compound is therefore a stronger radical scavenger than either HPir or CuCl(2). A molecular mechanics (MM) analysis of the gas phase structures of neutral HPir, its zwitterionic (HPir(+-)) and anionic (Pir(-)) forms, and some Cu(II)-piroxicam complexes based on X-ray structures allowed calculation of force constants. The most stable structure for HPir has a ZZZ conformation similar to that found in the Cu(II) (and Cd(II) complexes) in the solid state as well as in the gas phase. The structure is stabilized by a strong H bond which involves the N(amide)-H and O(enolic) groups. The MM simulation for the [Cu(II)(Pir)(2)(DMF)(2)] complex showed that two high repulsive intramolecular contacts exist between a pyridyl hydrogen atom of one Pir(-) molecule with the O donor of the other ligand. These interactions activate a transition toward a pseudo-tetrahedral geometry, in the case the apical ligands are removed. On refluxing a suspension of [Cu(II)(Pir)(2)(DMF)(2)] in acetone a brown microcystalline solid with the Cu(Pir)(2).0.5DMF stoichiometry was in fact prepared. (13)C spin-lattice relaxation rates of neutral, zwitterionic and anionic piroxicam, in DMSO solution are explained by the thermal equilibrium between the three most stable structures of the three forms, thus confirming the high quality of the force field. The EPR spectrum of [Cu(II)(Pir)(2)(DMF)(2)] (DMSO/GLY, 2:1, v/v, 298 and 110 K) agrees with a N2O2+O2 pseudo-octahedral coordination geometry. The EPR spectrum of [Cu(II)(Pir)(2).0.5DMF agrees with a pseudo-tetrahedral coordination geometry. The parameters extracted from the room temperature spectra of the solution phases are in agreement with the data reported for powder and frozen solutions. The extended-Hückel calculations on minimum energy structures of [Cu(II)(Pir)(2)(DMF)(2)] and [Cu(II)(Pir)(2)] (square planar) revealed that the HOMOs have a relevant character of d(x) (2)-y(2). On the other hand the HOMO of a computer generated structure for [Cu(II)(Pir)(2)] (pseudo-tetrahedral) has a relevant character of d(xy) atomic orbital. A d(xy) orbital is better suited to allow a dpi-ppi interaction to the O(2) (-) anion. Therefore this work shows that the anti-inflammatory activity of piroxicam could be due in part to the formation of [Cu(II)(Pir)(2)] chelates, which can exert a SOD-like activity.

Long-term i.v. Ig treatment in systemic lupus erythematosus.

OBJECTIVE: Treatment of SLE exacerbations with intravenous gammaglobulins has been shown to be safe and effective, leading to both clinical and serological improvement. In this study we test the hypothesis that intravenous immunoglobulins (IVIg), administered over a long period, would also be effective in patients with chronically active SLE. DESIGN AND PATIENTS: An open trial was carried out on 12 patients with SLE refractory to conventional treatments, administering monthly infusions of intravenous immunoglobulins at a dose of 400 mg/kg/day for 5 consecutive days. The therapy (400 mg/kg for 5 days) lasted from 6 up to 24 months. RESULTS: Progressive clinical improvement was observed in 11 patients during the entire treatment course. This improvement was associated with an increase in hemoglobin, total serum hemolytic complement activity and C3 and C4 components, and in 2 thrombocytopenic patients in the platelet count, as well as a progressive reduction of ESR, serum immunocomplexes and antinuclear antibodies. A marked improvement in serum urea, creatinine clearance and proteinuria was also observed in those patients with renal involvement. We did not observe any adverse effects. CONCLUSION: The results obtained suggest that IVIg therapy may be a promising option in the treatment of chronically active SLE; however, further evaluation of this therapy is essential.

[Long-term treatment with i.v. immunoglobulin in the therapy of systemic lupus erythematosus]. / Trattamento a lungo termine con immunoglobulina e.v. nel terapia del lupus eritematoso sistemico.

BACKGROUND: Treatment of several autoimmune diseases with intravenous gammaglobulins (IvIg) has been demonstrated to be safe and effective in determining clinical improvement and decreasing autoantibody titer. We tested the hypothesis that IvIg would be effective in patients with Systemic Lupus Erythematosus (SLE). METHODS: We conducted an open trial involving 12 patients with SLE refractory to conventional treatments with monthly infusion of IvIg at a dosage of 400 mg/kg/day for 5 consecutive days. The duration of the therapy with the same dose every 4 weeks was from 16 to 24 months. RESULTS: A progressive clinical improvement was observed in 11 patients during IvIg therapy, and it persisted during the all period of treatment. The clinical improvement was associated with an increase of haemoglobin, albumin levels, total serum complement and C3 and C4 components, platelets count in 2 thrombocytopenic patients, and a progressive reduction of ESR, plasma immunocomplexes and antinuclear antibodies. A marked improvement in serum urea, creatinine clearance and proteinuria was also observed in the patients with renal involvement. We have not observed any adverse effects with the long-term use of this treatment. Several mechanisms have been postulated to explain the effect of IVIg in the treatment of autoimmune diseases. Many experimental and clinical data support the interesting hypothesis that IVIg may be effective in some autoimmune diseases by restoring a normal function or the physiological immune network through the same regulatory mechanisms leading to a suppression of autoimmune disorders in normal individuals. The presence of a wide spectrum of anti-idiotypic antibodies in IVIg could regulate T and B-cell activities preventing the emergence of B-cell clones with specificity for autoantigens epitopes and down-regulating autoantibodies production. CONCLUSION: The results obtained suggest that IvIg therapy seems to be a promising and beneficial approach in the treatment of SLE. However, double-blind studies are necessary to confirm the results obtained particularly to ascertain the optimal dosage, the schedule of infusion and the duration of maintenance therapy with IVIg, and to determine their long-term effectiveness, the reduction in late morbidity and mortality and the effect on the quality of life of patients with SLE. Moreover, because of the high cost of IVIg, their use seems to be especially indicated for patients non responders to conventional treatments and for these with infectious complications.

Experimental diode laser-assisted microvascular anastomosis.

An experimental study to evaluate a diode-laser approach to microvascular end-to-end anastomoses is reported. Studies were carried out on the femoral arteries and veins of Wistar rats, and effective welding of vessel tissue was obtained at low laser power, by enhancing laser absorption with indocyanine green (Cardio-green) solution. The histologic and surgical effects of this laser technique were examined and compared with those of conventional microvascular sutured anastomoses.

[Evaluation of the efficacy of intra-articular administration of somatostatin in rheumatoid arthritis]. / Valutazione dell'efficacia della somatostatina per via intrarticolare in pazienti con artrite reumatoide.

The above study was undertaken in order to evaluate the efficacy of intra-articular somatostatin in rheumatoid arthritis. Twelve patients were enrolled and all of them concluded the experiment of three consecutive intra-articular somatostatin injections of 750 mcg at two-weekly intervals. All patients reported a statistically significant reduction in painful symptomatology, particularly of pain during active movement, pain at climbing stairs, and morning stiffness. In one patient, telethermography revealed complete subsidence of articular inflammation. There were neither local nor systemic side effects.

[Ketoprofen efficacy and tolerance in simple painful shoulder]. / Efficacia e tollerabilità del ketoprofene nella spalla dolorosa semplice.

Thirty patients presenting with painful shoulder syndrome were treated with i.m. ketoprofen 100 mg b.d. for 8 days to assess the efficacy and tolerance of the above treatment regime. The patients' condition was monitored by clinical, instrumental and laboratory examinations. Ketoprofen was found to be significantly effective in all cases of non calcific rotator cuff tendinitis while no improvement was noted in calcific tendinitis. The above data confirm the efficacy and tolerance of ketoprofen in the treatment of painful shoulder syndrome as an alternative to local steroid therapy.

[An unusual case of dermatofibrosarcoma protuberans]. / Un insolito caso di dermatofibrosarcoma protuberans.

A case of Dermatofibrosarcoma Protuberans (DFSP) with unusual cystic features is described. It is difficult to evaluate the actual incidence of this feature on the basis of literature; on the other hand we observed it only once in a series of 27 patients studied from 1975-1989.

Bilateral chondroma of the auricle.

Benign extraosseous cartilaginous lesions are uncommon and favor mainly the soft tissues of the hands and feet. We report a case of chondroma of both auricles. This localization has not been previously reported in the literature.