Thin Primary Cutaneous Melanoma in Childhood and Adolescence: Report of 12 Cases

Abstract:  Approximately, 1–4% of all new melanoma cases occur in patients younger than 20 years. The clinical presentation of melanoma in the young is often challenging. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy. Study subjects were drawn from 1470 patients with histologically confirmed melanoma. From this group, melanoma developed in 12 patients younger than 19 years. For each melanoma diagnosed, histologic characteristics, treatment, and outcomes were evaluated. Of the 12 patients described in this study, four were men and eight were women. The average age was 15.6 years ranging from 11 to 18 years. Regarding invasive melanomas, Breslow thickness ranged from 0.15 to 0.66 mm with a mean thickness of 0.36 mm. Primary treatment of 12 patients included wide local excision of their primary lesions. In many cases reported in literature lesions are amelanotic, nodular, and resemble pyogenic granuloma. From our case studies it was found that the clinical characteristics detected in melanomas diagnosed in childhood and adolescence have been the same as those described in adults and that the ABCDE clinical criteria may be helpful basics of melanoma.     

Longitudinal neuropsychological evaluation of HIV-infected intravenous drug users

The present study aimed to describe the cognitive status of a group of HIV-positive asymptomatic intravenous drug users (IVDU) and changes which occurred over a 12-month follow-up period. Forty-two HIV positive IVDU were selected and matched for age, sex, educational level and pattern of drug abuse with 39 seronegative IVDU controls. Baseline and follow-up evaluation included neuropsychological tests exploring attention, language, memory, logic and visuomotor abilities, biological markers and clinical parameters. About one-third of both seropositive and seronegative subjects showed at baseline slight cognitive deficits, ‘which did not change during the follow-up period.     

EFFECTS OF FLUVOXAMINE AND CITALOPRAM IN MAINTAINING ABSTINENCE IN A SAMPLE OF ITALIAN DETOXIFIED ALCOHOLICS

A 16-week, randomized study was performed to test the efficacyof two selective serotonin reuptake inhibitors (SSRIs) fluvoxamineand citalopram, in decreasing relapse and craving in alcoholics,and to investigate possible differences in their clinical profile.After detoxification, each of the 81 patients (55 males and26 females) was randomly assigned to one of three groups: 23subjects did not receive any pharmacological treatment, 25 weretreated with fluvoxamine, 150mg/day, and 33 with citalopram.20mg/day. All patients received standard cognitive-behaviouraltherapy. Craving was assessed twice a month using a 10-stepscale. Every intake of alcohol was considered a relapse andthe subject was taken out of the study. At the end of the study,both the fluvoxamine and citalopram groups showed a statisticallyhigher rate of continuous abstinence (63.6 and 60.7%, respectively)compared to the group without pharmacological treatment (30.4%).Relapse severity did not differ among the three groups. Onlycitalopram showed a significant effect on craving throughoutthe study period. This study confirmed the efficacy of SSRIsas an adjunct to psychotherapy to prevent relapse in alcoholics.The relationship between the effects of these SSRIs on abstinenceand craving, as well as the differences between their profiles,are discussed.     

A simple new technique to prevent bleeding in transplant nephrectomy

Renal transplantectomy is still a frequent procedure for a transplant surgeon. Nevertheless, it is constantly marred by complications, first of all bleeding. In fact, the local circumstances after the operation and the general health state of the uremic patients lead to a high incidence of this complication. To avoid this, we adopt a particular technique for renal extracapsular transplantectomy, performing three running sutures between the two faces of the renal capsule. This prevents the formation of the hematoma which is the basis of the continuous bleeding and following infection. We collected a series of nine patients who underwent transplantectomy in which we used this technique. No complications were noted.     

Sexual function before and after mesh repair of inguinal hernia

AIM: Several factors having an influence on the quality of life after an inguinal hernia repair have been studied, yet little has been reported on sexual function before and after this operation. METHODS: In a prospective follow-up study from January 1999 to July 2002, 210 men and 14 women were asked to answer an anonymous questionnaire of 40 questions before elective inguinal hernia repair to assess pre- and postoperative sexual function (preoperatively, 3 months postoperatively and every 6 months afterwards). Inguinal hernia repair was performed using a standardized Plug and Patch mesh technique. RESULTS: Fifty-two (23.2%) patients mentioned preoperative sexual dysfunction related to the groin hernia. Postoperatively, the surgical repair had a positive influence on the sexual function in these patients. Thirty-six (16%) patients complained of postoperative sexual dysfunctions, which improved or disappeared over the next few months. All patients suffered surgical complications, which were surgically treated in six cases. Symptoms specifically associated with inguinal hernias can cause certain limitations in the sexual life. CONCLUSIONS: In most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life in patients with preoperative sexual dysfunction, while, in most cases, it does not affect patients with a preoperative normal sexual life.     

Analysis of the Role of Nitric Oxide in the Relaxant Effect of the Crude Extract and Fractions from Eugenia uniflora in the Rat Thoracic Aorta

This study has evaluated the possible role played by the l-arginine-nitric oxide pathway in the vasorelaxant action of the hydroalcoholic extract from Eugenia uniflora, and fractions from the extract, in rings of rat thoracic aorta. The addition of an increasing cumulative concentration of hydroalcoholic extract from E. uniflora (1–300 μg mL^?1) caused a concentration-dependent relaxation response in intact endothelium-thoracic aorta rings pre-contracted with noradrenaline (30–100 nm). The IC50 value, with its respective confidence limit, and the maximum relaxation (R_max) were 7.02 (4.77–10.00) μg mL^?1 and 83.94 ± 3.04%, respectively. The removal of the endothelium completely abolished these responses. The nitric oxide synthase inhibitors N^ω-nitro-l-arginine (l-NOARG, 30 μm) and N^ω-nitro-l-arginine methyl ester (l-NAME, 30 μm), inhibited the relaxation (R_max) to ?10.43 ± 7.81% and ?3.69 ± 2.62%, respectively. In addition, l-arginine (1 mm), but not d-arginine (1 mm), completely reversed inhibition by l-NOARG. Methylene blue (30 μm), a soluble guanylate cyclase inhibitor, reduced the relaxation induced by the extract to 14.60 ± 7.40%. These data indicate that in the rat thoracic aorta the hydroalcoholic extract, and its fractions, from the leaves of E. uniflora have graded and endothelium-dependent vasorelaxant effects.