Interval Sentinel Lymph Nodes: An Unusual Localization in Patients with Cutaneous Melanoma

Background. Recent studies have demonstrated that there exists a great variation in the lymphatic drainage in patients with malignant melanoma. Some patients have drainage to lymph nodes outside of conventional nodal basins. The lymph nodes that exist between a primary melanoma and its regional nodal basin are defined “interval nodes”. Interval node occurs in a small minority of patients with forearm melanoma. We report our experience of the Melanoma Unit of University Hospital Spedali Civili Brescia, Italy. Methods. Lymphatic mapping using cutaneous lymphoscintigraphy (LS) has become a standard preoperative diagnostic procedure to locate the sentinel lymph nodes (SLNs) in cutaneous melanoma. We used LS to identify sentinel lymph nodes biopsy (SLNB) in 480 patients. Results. From over 2100 patients affected by cutaneous melanoma, we identified 2 interval nodes in 480 patients with SLNB . The melanomas were both located in the left forearm. The interval nodes were also both located in the left arm. Conclusion. The combination of preoperative LS and intraoperative hand-held gamma detecting probe plays a remarkable role in identifying these uncommon lymph node locations. Knowledge of the unusual drainage patterns will help to ensure the accuracy and the completeness of sentinel nodes identification

Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

Background: Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods: We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction (LVEF), functional mitral regurgitation (FMR) grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results: Ninety-three patients (68.2+/-10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-month follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0+/-17.8 vs. 2.7+/-13.5, P=0.002), sustained VT or ventricular fibrillation (0.9+/-2.5 vs. 0.5+/-2.9, P=0.012) and ICD antitachycardia therapies (2.5+/-12.0 vs. 0.9+/-5.0, P=0.033) were observed. Conclusions: PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort

In vitro phosphorylation as tool for modification of silk and keratin fibrous materials

An overview is given of the recent work on in vitro enzymatic phosphorylation of silk fibroin and human hair keratin. Opposing to many chemical "conventional" approaches, enzymatic phosphorylation is in fact a mild reaction and the treatment falls within "green chemistry" approach. Silk and keratin are not phosphorylated in vivo, but in vitro. This enzyme-driven modification is a major technological breakthrough. Harsh chemical chemicals are avoided, and mild conditions make enzymatic phosphorylation a real "green chemistry" approach. The current communication presents a novel approach stating that enzyme phosphorylation may be used as a tool to modify the surface charge of biocompatible materials such as keratin and silk

Immunomorphological analysis of the role of blood vessel endothelium in the morphogenesis of cutaneous Kaposi's sarcoma: a study of 57 cases

In this study we report the histopathological features in a series of 88 biopsies from patients with cutaneous Kaposi's sarcoma; immunohistochemical examination for Factor VIII related antigen has been carried out on frozen and paraffin-embedded sections. The patient groups comprised 50 elderly patients, seven of whom were immuno-compromised, six patients with AIDS and one patient who had received a renal allograft. The findings were similar in these three groups. Histological staging was carried out with subdivision into stage I--patches characterized by angiomatoid and glomeruloid structures; stage II--plaques characterized by confluence of angiomatoid and glomeruloid structures and with spindle cells; and stage III--nodules in which the spindle cells were proliferative and frankly sarcomatous. Factor VIII related antigen was demonstrated in the central vessels of glomeruloid lesions whilst the surrounding vascular network contained both antigen-negative and antigen-positive vessels; in stage II and III lesions the spindle cells were consistently positive only in frozen section material. The findings were similar in the three patient groups. Our results suggest that Kaposi's sarcoma evolves from stage I through to stage III, that both blood vessels and lymphatic vessels are involved in the vascular proliferation and that the spindle cells are derived from vascular endothelium

[Immunohistochemical study of porokeratosis in kidney transplantation]

Six cases of disseminated actinic superficial porokeratosis are reported in kidney transplant recipients. Immunohistochemistry study showed an altered state of Langerhans cell surface markers at the level of the cutaneous lesions of porokeratosis. We can hypothesize that the alterate state of epidermal dendritic cells in porokeratosis contributes to the development of abnormal clones of keratinocytes