Super-high magnification dermoscopy can aid the differential diagnosis between melanoma and atypical naevi.

BACKGROUND: Dermoscopy is the most widely used noninvasive imaging technique for the clinical diagnosis of melanoma (MM). Super-high (× 400) magnification dermoscopy (D400) has recently been developed; compared with traditional dermoscopy, it can reveal additional features, down to the identification of single melanocytes in the skin. OBJECTIVES: To evaluate which structures are visible at D400 and to compare them in atypical naevi and MMs. METHODS: A prospective observational multicentre study was conducted. We enrolled patients who were identified as having atypical melanocytic skin lesions by clinical and/or × 20 magnification dermoscopy (D20) examination, and who were assigned to either excision or follow-up. Lesions were imaged by videodermoscopy at D20 and D400. The presence of pigmented cells and their features were assessed at D400. RESULTS: In total, there were 79 patients with 57 naevi and 31 MMs. Of the total 88 lesions, 63 (71.6%) were given a histological diagnosis, while the others were followed up for ≥ 12 months, during which they showed no change and were all diagnosed as naevi. Pigmented cells were identified in > 90% of the lesions at D400. Compared with naevi, MMs had a higher frequency of scattered, large, irregular (in shape and size), dendritic/roundish, violet/blue pigmented cells under D400 (P < 0.001). Moreover, dots (P < 0.01), out-of-focus blue structureless areas (P < 0.01) and vessels (P < 0.001) were also more frequent in MMs than in naevi at D400. CONCLUSIONS: This study showed that D400 can reveal many elements not otherwise visible in traditional D20 dermoscopy, such as pigmented cells and their morphology, which could be useful for the diagnosis of MM.

[Early diagnosis and correct treatment of varicocele in puberty]. / Diagnosi precoce e trattamento corretto del varicocele in periodo puberale.

Varicocele normally presents itself in adolescence, with an incidence of 16 per cent. Less than one third of the boys, though, will suffer from male infertility in adulthood. Therefore, it seems excessive as well as imprudent to suggest surgery to all those patients. We worked out some parameters to identify "risky" cases of varicocele. From June to November 1990 we studied 45 patients from 10 to 16 years of age affected by varicocele, taking into consideration the following factors: puberal phase, symptomatology, degree of varicocele, testicular volume, Doppler ultrasound, hormonal profile. A Doppler ultrasound test evidenced a clinically undetected right reflux, in addition to a left varicocele, in 13 patients (34.4%). Sixty per cent of these 13 patients revealed a pathological response to LHRH test; this incidence is very close to that evidence in clinical bilateral varicocele. We believe that a right reflux showed by ultrasounds, represents a cause of further alteration in the patient's endocrinological balance in addition to increasing his risk of infertility. Purpose of this study was to draw a guideline for early diagnosis, correct treatment and follow-up of varicocele in peripubertal age.

[Seminal duct abnormalities in cryptorchism: our experience with 334 cases]. / Anomalie della via seminale nel criptorchidismo: nostra esperienza su 334 casi.

Undescended testis is one of the most common anomalies in pediatric age; despite numerous theories offered to explain its etiology, the true mechanism of the anomaly seems not to have been fully elucidated. The purpose of this prospective study was to investigate the incidence of epididymal abnormalities in undescended testes, the potential role of these anomalies in testicular descent and in incidental infertility. All patients were submitted to orchidopexy during which the complete anatomical situation of the epididymis and vas deferens was detected. In a group of 334 testes the incidence of congenital defects was 68%. The severity of these abnormalities appeared to be strictly correlated to the level of undescended testis. The incidence was 85% when the testis was in the abdomen, 82% when in the inguinal canal, 63% when next to the external inguinal ring and 53% when the testis was ectopic. The epididymal detachment at the head was the most common anomaly (113 cases), followed by extended epididymis (91 cases) and by total detachment of epididymis from the testis (70 cases).

Tumor markers (CEA, TPA and CA 19-9) in urine of bladder cancer patients.

This study was carried out to evaluate the usefulness of determining urinary levels of carcinoembryogenic antigen (CEA), tissue-polypeptide antigen (TPA), and gastro-intestinal cancer antigen (Ca19-9) in addition to the usual diagnostic procedures for bladder cancer. Sixty-seven patients with transitional bladder cancer, 40 healthy controls and 20 patients with inflammatory diseases of the urinary tract were considered. All urine samples were obtained from patients with intact renal function and no urinary tract infection. TPA and Ca19-9 urinary levels in patients with G3 bladder tumors were significantly higher than in those with lower graded neoplasms. The sensitivity, specificity, and predictive value of a positive (PV+) or negative (PV-) test and the diagnostic accuracy were also evaluated. Ca19-9 was the best urinary marker for bladder cancer (sensitivity 71.6%, specificity 91.6%, PV+ 90.5%, PV- 74.3%, diagnostic accuracy 81%).

[Blood and urinary values of CEA and CA 19-9 in patients with bladder carcinoma]. / Valori ematici ed urinari di CEA e Ca 19-9 in pazienti affetti da carcinoma vescicale.

Carcinoembryonic antigen (CEA) and Ca 19-9 levels in urine and serum from 46 patients with bladder cancer in varying stages have been evaluated. All samples of urine were obtained germ-free and without bacterial infection in the bladder. The sensitivity of CEA monoclonal antibody is 60.8% and specificity is 80%. Ca 19-9 test has higher sensitivity (74%) and the same specificity. Correlation between staging, grading and CEA or Ca 19-9 values were also evaluated.