[The posturological department as clinical support for occupational medicine: clinical cases and results of a hospital unit]. / L'ambulatorio di posturologia come supporto specialistico per la medicina del lavoro--casistica e risultati della pratica clinica di una struttura ospedaliera.

The posturologic visit is a not widely known medical method for the evaluation and the therapy of low back pain. We describe the clinical and instrumental method followed in our posturological clinical unit organized jointly by hospital and university and the clinical cases evaluated in two years. An individual diagnostic evaluation and a personal therapy allowed an almost generalized complete remission of the symptoms and a very low number of reactivation of low back pain after a follow up of one years.

Reliability and accuracy of sentinel node biopsy in cutaneous malignant melanoma.

AIMS AND BACKGROUND: The aims of this study were 1) to investigate whether sentinel lymph node (SLN) biopsy could become the method of choice for the early detection of metastatic disease in patients with malignant melanoma and 2) to identify those patients with lymph node metastases who could benefit from regional lymphadenectomy. METHODS AND STUDY DESIGN: Our study started in March 1998 and involved 110 patients with primary cutaneous malignant melanoma stage I or II (AJCC) in whom the primary lesion had been surgically removed no more than 90 days previously. On the day of lymph node dissection patients were given an intradermal injection of colloid particles of human serum albumin labeled with technetium-99m and an injection of isosulfan blue. The surgical procedure was usually performed with local anesthesia but in some cases locoregional or general anesthesia was preferred. Contralateral and ipsilateral lymphatic areas were scanned with a hand-held gamma camera (Scintiprobe MR 100) to measure the background and identify the hot point indicating the location of the sentinel node to direct the incision. RESULTS: The combined use of lymphoscintigraphy, isosulfan blue and gamma probe allowed us to identify sentinel nodes in 108 of 110 patients (98.18%) while the SLN was blue in only 90 cases (81.81%). The SLN was positive for metastases in 13 of the 108 patients (12.03%) and regional and distal lymphadenectomy was performed in all of them. The distribution of positive SLNs by primary lesion thickness was as follows: 0.76-1.5 mm: one positive SLN/44 patients (2.27%); 1.51-4 mm: six positive SLNs/51 patients (11.7%); > 4 mm: six positive SLNs/15 patients (40%). Only four of 12 patients with ulcerated cutaneous melanoma had positive SLNs. The patients in our study underwent follow-up visits every four months. The median follow-up was 481 days (range, 97-1271 days). CONCLUSIONS: In patients with primary cutaneous melanoma the histological status of the SLN accurately reflects the presence or absence of metastatic disease in the relevant regional lymph node basin. Complete lymph node dissection should only be performed in patients with positive SLNs. Patients with lesions > 4 mm are likely to develop recurrences and to die of systemic disease, so in these patients the usefulness of SLN biopsy is questionable. In conclusion, sentinel node mapping is a rational approach for the selection of patients who might benefit from early lymph node dissection of the affected basin.

Hepatic actinomycosis presenting as liver mass: case report and review of the literature.

Primary hepatic actinomycosis is an uncommon entity. We report the case of a young man with past history of an appendectomy who presented with fever, weight loss and a liver mass that was initially suspected to be neoplastic. Percutaneous liver biopsy revealed actinomyces-like organisms. The patient was treated with intravenous and oral penicillin with good therapeutic response. Review of the literature and correlation between hepatic actinomycosis and previous appendectomy are considered.

Basal cell carcinoma arising in pemphigus vulgaris of the lower eyelid.

A 59-year-old woman on continuous treatment with corticosteroids and immunosuppressive drugs for pemphigus vulgaris of 14 year's duration presented with an enlarging nodular lesion on the right lower eyelid. The neoplasm, diagnosed as basal cell carcinoma, was excised conserving the lid margin, and eyelid reconstruction was done with a rotated cheek flap. Wound healing proceeded without complications in spite of immunosuppressive treatment, and the final cosmetic and functional result was satisfactory.

Surgical treatment for aggressive giant keratoacanthoma of the face.

A case of aggressive giant keratoacanthoma on the right temple region is described. Histopathologic examination was not definitive for keratoacanthoma, so that clinical considerations were helpful for diagnosis. The neoplasm was treated successfully with surgical excision and immediate repair with skin graft, in spite of one narrow peripheral area of residual disease on the wound surface after resection.

Excision of a malignant neoplasm from a lower lip and reconstruction by a step technique of flaps.

A step technique of flaps is described, illustrated, and recommended for full-thickness defeats of up to two-thirds of the lower lip. The mobility of the lip, the sphincter function of its musculature, and cosmetic result of the reconstituted lips were found to be excellent from such a procedure.