Classical Kaposi's sarcoma: a survey of 163 cases observed in Bari, south Italy.

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.

Cutaneous vasculitis as the sole manifestation of disseminated gonococcal infection: case report.

One of the possible systemic complications of gonorrhoea is disseminated gonococcal infection (DGI), which is usually characterised by both skin and joint lesions. While joint involvement ranges from tenosynovitis to suppurative arthritis, cutaneous involvement features varied non-specific patterns often clinically and histologically consistent with vasculitis. We report a case of DGI in which an extensive, vesicobullous, haemorrhagic, and necrotic cutaneous vasculitis was the sole manifestation of the disease.

Cutaneous sporotrichosis in the period 1978-1992 in the province of Bari, Apulia, Southern Italy.

The authors report 16 cases of cutaneous sporotrichosis observed in the province of Bari, southern Italy, since 1978. While no more than 55 cases have been documented in other European countries in the last 30 years, in Italy 58 cases (present series included) have been recorded in the same time period. Furthermore, 42 of them (73.7%) originated from Apulia. This unexpectedly high incidence rate in Italy, and in Apulia in particular, provides evidence of the important role played by this area in the ecoepidemiology of sporotrichosis in Europe.

[Clinico-epidemiological findings in tinea capitis in adults]. / Osservazioni clinico-epidemiologiche in tema di Tinea capitis dell'adulto.

Clinical and epidemiological data on 15 subjects with Tinea capitis are reported. The patients, aged between 19 and 74, were observed from 1.1.1980 to 30.6.1990; 14 of them were females. The evidence of different clinical pictures is stressed. Microsporum canis was isolated in 7 cases, Trichophyton violaceum in 6 cases, and Trichophyton schoenleinii in 2 cases.

[A retrospective study of 200 cases of lichen]. / Indagine retrospettiva su 200 casi di lichen.

In this study the data on 200 patients affected by various features of lichen planus (LP) are reported. All subjects were in-patients of the Department of Dermatology, Bari, from 1973 to 1988. In 87% of cases the disease appeared as lichen tuber planus, and in 9% there was involvement of mucous membranes. Equal involvement of sex incidence has been found, and the patients were middle-aged (mean, 47 years). The lesion were not subsided in about 10% of cases. Associated fortuitous skin conditions were mainly alopecia areata and vitiligo. In addition, LP has been observed in association with diabetes (8%) and hepatic diseases (10%). These last values could appear relevant, but in our region, Apulia, both diabetes and hepatitis, and especially B-hepatitis, are very frequent diseases. Our clinical follow-up did not allow to consider LP as a symptom of other subsequent organic diseases.

[Clinico-pathogenetic observations on the subject of "superficial vasculitis"]. / Osservazioni clinico-patogenetiche in tema di "vasculiti superficiali".

A clinical, histopathologic, laboratory and therapeutic study in 44 subjects with "superficial vasculitis", consecutively observed during the last two years, has been carried out. The findings showed that 1. the anamnesis was sometimes not relevant; 2. the clinical pictures were not in a regular manner correlated with histologic reports (a polymorphonuclear infiltrate with leukocytoclasis or a lymphomononuclear + one); and 3. a non-correlation between clinical, histologic and etiologic data. Infectious agents were responsible, mostly pyogenic bacteria, Mycobacterium tuberculosis, and hepatitis B virus; Chlamydiae were rarely responsible, whereas the etiologic role of Toxoplasma was uncertain. In this respect, drugs were not relevant. All these agents seem to act on the immunological response of the patient with previous microvascular changes (diabetes, chronic venous insufficiency). The latter condition seems to play a predominant role: the recovery of the lesions and/or their relapse shows the same behaviour both in case of etiological and symptomatic therapy.

Cell-mediated immune response in psoriasis and psoriatic arthritis.

It has been previously described an impairment of cell-mediated immune response in psoriasis. In the present paper we have evaluated lymphocyte surface markers, non specific immunity, lymphokine secretion and antibody synthesis in a group of patients with psoriasis (PS) and with anti-inflammatory drug treated or gold-treated psoriatic arthritis (PsA). No significant differences are found in terms of T lymphocyte subpopulation frequency, even if a lower CD8+/CD4+ ratio was observed in all patients. In spite of an increased percentage of B lymphocytes, B cell polyclonal response is significantly decreased in the presence of either T cell-independent or T cell-dependent polyclonal activator. Further studies provide additional supports to these findings, since all psoriatic patients exhibit a deficit of T helper function in an antibody-specific induction system. Gold therapy in PsA led to a partial recovery of T helper function, without affecting the immunoglobulin reduced synthesis. With particular reference to non-specific activities mediated by monocytes and polymorphs (PMN), PMN chemotaxis, phagocytosis and killing and monocyte-mediated phagocytosis are reduced, except for monocyte phagocytosis in anti-inflammatory treated PsA or PMN chemotaxis in gold-treated PsA. Finally, lymphokine release is significantly decreased in all patients. In conclusion, our data provide further evidence for the impairment of immune response in psoriasis and PsA, which may in turn play a key role in the pathogenesis of psoriasis.

Histological changes in rabbits after application of medicaments and cosmetic bases (III).

An experimental study is reported of the irritant potential of oil of purcellin , isopropyl palmitate, nonyl phenol, Modulan , Amerchol and Acetulan when massaged in fixed amounts into the rabbit's skin daily for 30 days. Skin biopsies provided data on the number of epithelial cell layers, cell counts of the superficial dermis, and the fibre and basement membrane changes. All the test compounds induced changes in the form of increased number of epithelial cell layers and of the papillary dermis cell count, more marked for Acetulan or Amerchol . The difficulties in the evaluation of the results and their applications to human pathology are discussed.

Experimental sensitization of guinea pigs by drugs. Comparison of the maximization test with the wholly intradermal test.

The capacity of tegobetain, pyrrolnitrin, tolcyclate and chlorquinaldol to induce delayed-type contact sensitization was studied in guinea pigs in 2 series of tests using the method of Magnusson & Kligman and the authors' modification of the wholly intradermal Draize technique. Histological examination of skin biopsies obtained from the test area demonstrated that tegobetain, pyrrolnitrin and tolcyclate are potential sensitizers.

Histological changes in rabbits after application of medicaments and cosmetic bases. II.

A further study of the topical effects of certain pharmaceutical and cosmetic bases on rabbit skin is reported. Cetyl alcohol, myristic acid, castor oil and sorbitol were applied in fixed doses daily for 30 days and their irritant activity was assessed. The macroscopic and microscopic changes were on the whole minimal. Castor oil alone produced some macroscopic alterations in the form of slight erythema and edema, and microscopic changes consisting of acanthosis, disorganization of the basal layer and slight infiltration of the dermis.