Oral melanoma with osteocartilagineous differentiation: a case report and literature review.

Osteocartilagineous differentiation within malignant melanoma is a rare occurrence with several implications for diagnosis. Most of the reported cases have occurred in acral lentiginous malignant melanomas. In this paper, the authors describe the clinical, morphological, immunohistochemical features and surgical treatment of a case of primary oral mucosal melanoma with osteocartilaginous differentiation and they review the existing literature. The clinical history of a 67-year-old man affected of oral malignant melanoma was described from the first presentation to the second recurrence. FISH analysis on primary lesion and on relapses showed positive results both in epithelioid and in osteocondroblastic areas. Because of the scarcity of literature in osteogenic melanoma, histological identification may be problematic and prognostic factors and therapeutic protocols are nor well established. Immunohistochemical and molecular techniques can help to diagnosis this rare lesion.

Reconstruction of partial maxillary defects with the double-barrel fibula free flap.

Maxillary reconstruction still remains challenging for surgeons despite the fact that maxilla is a static structure. The correct shape and volume of the reconstruction can guarantee the best result in terms of soft tissue support and functional outcome for the patients restoring three-dimensional support of the mid third. The fibula free flap seems to be the best free flap to apply in this type of reconstruction, partial maxillectomy, in particular, can benefit from reconstruction with the double barrelled fibula free flap. In fact, this shape can provide the best support to cheek tissue and minimize the tendency of upper retraction of the alar base of the nose and lips. Moreover, the free flap, containing bone, can restore a skeletal structure that will provide adequate bony support for osteointegrated implant prosthesis rehabilitation. All these conditions can be achieved with the double barrel fibula flap that we consider a good approach for maxillary reconstruction.

Spirituality of health workers: a descriptive study.

BACKGROUND: The World Health Organisation defines health as "a state of complete physical, mental and social well-being, not merely the absence of disease or infermity". In May 1984 the spiritual dimension became part of WHO Member States' strategies for health. The WHO defines quality of life as "individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns." PURPOSE: To test health workers' quality of life (QOL) with regard to their spirituality. METHODS: The WHOQOL SRPB-domain 6 was used. It denotes an individual's perception of quality of life, as far as spirituality is concerned. The sample was formed by 116 health workers from three wards of three Rehabilitation Hospitals owned by the Brothers of Saint John of God, in Northern Italy. RESULTS: The sample shows means above the mid-point in all facets denoting reasonably good quality of life in the domain of spirituality. The most significative variables are: health conditions (p = .001*), religiousness (p < or = .0005**), personal creed (p < or = .0005**). IMPLICATIONS: The sample's quality of life in the domain of spirituality is reasonably good. Our findings suggest that spirituality is associated with the subjective perception of people's health status.

Quantitative analysis of apoptosis and bcl-2 in Sjögren's syndrome.

OBJECTIVE: To determine whether apoptosis plays a significant role in tissue damage of Sjögren's syndrome (SS). METHODS: We performed a quantitative analysis of programmed cell death on salivary glands of 11 patients. Ten age matched women with sicca syndrome served as controls. Morphometric measurement of the fractional volume of acini and ducts showing DNA strand breaks was performed in sections stained by deoxynucleotidyl transferase assay. The extent of bcl-2 expression was determined in sections labeled with monoclonal antibody. The different cell populations infiltrating the glands were examined in tissues stained with anti-leukocyte common antigen and OPD4 monoclonal antibodies. RESULTS: In patients with SS, 68% of the ductal epithelium was occupied by apoptotic structures, whereas only 12% of acini showed DNA strand breaks. Corresponding values in control salivary glands were 3 and 0.13%. bcl-2 labeling was higher in ducts than in acini of both control and pathologic glands. However, in SS a 43% (p < 0.001) and 75% (p < 0.001) reduction in bcl-2 expression was observed in ductal and acinar epithelium, respectively. In comparison with controls, the numerical density of CD4+ cells and plasma cells scattered throughout the interstitium was 323% and 203% higher (p < 0.001) in SS. Moreover, T helper/inducer lymphocytes represented 52% of the inflammatory foci. CONCLUSION: Apoptosis occurs in minor salivary glands of patients with SS with a prevailing localization on the ductal epithelium in association with downregulation of bcl-2 and a large number of infiltrating CD4+ lymphocytes. Thus, the destruction of glandular tissue and the loss of secretory function in SS is dependent on the activation of the suicide program of epithelial cells.