[Paracoccidioidomycosis of the external ear]. / Paracoccidioïdomycose localisée au pavillon d'une oreille.

BACKGROUND: Paracoccidioidomycosis is a systemic fungal infection common in Latin America. Cutaneous involvement is frequent and usually affects multiple sites, being most frequently associated with lesions of the oropharyngeal mucosa. The cutaneous form on its own is rare. PATIENTS AND METHODS: We report a case of paracoccidioidomycosis isolated from the ear of a 43-year-old immunocompetent man. The lesion consisted of a partially ulcerated plaque on the auricle of the left ear. Direct examination, histopathological examination and PCR revealed the presence in the skin lesion of yeasts identified as Paracoccidioides brasiliensis. DISCUSSION: The sites of paracoccidioidomycosis on the ear can be confused with other tropical diseases frequently found in the Amazon region such as leishmaniasis, leprosy and lobomycosis. The absence of any other cutaneous sites in this case raised the question of whether the lesion was of primary or secondary origin.

Eumycetoma caused by Diaporthe phaseolorum (Phomopsis phaseoli): a case report and a mini-review of Diaporthe/Phomopsis spp invasive infections in humans.

Diaporthe phaseolorum (syn. Phomopsis phaseoli) is a frequent fungal parasite of plants, present on all continents around the world. It has rarely been involved in human diseases. We report a case of eumycetoma with osteomyelitis of the forefoot caused by this fungus and diagnosed by molecular biology. The patient had positive HTLV-1 serology and was a farmer from French Guiana who walked barefoot. He was successfully treated with long-term oral itraconazole (400 mg/day). A review of the literature underlines the essential roles of plants and host immunosuppression in this infection and the favourable outcome with a triazole antifungal treatment.

p63 expression in odontogenic cysts.

A total of 123 cases of odontogenic cysts, distributed as follows: 30 follicular (FC), 35 radicular (RC), 53 keratocysts, 1 glandular odontogenic and 4 calcifying odontogenic cysts, were analysed by immunohistochemistry for expression of p63, a component of p53 protein family. In RCs p63 positivity was not only in basal and parabasal layers but also in the intermediate layer and about 1/3 of cases displayed a percentage of stained cells comprised between 0 and <5%, and about 2/3 between >5% and <50%. In FCs positivity was confined to basal and parabasal layers of the epithelium and in the majority of FCs the stained cells were comprised between 0 and <5%. OKCs displayed the most intense and diffuse p63 labeling. In conclusion, these data suggest that p63 expression may be useful to identify cysts type with more aggressive and invasive phenotype supporting the hypothesis of a suprabasal proliferative compartment in OKCs.

Maxillary post-traumatic outcome correction. Literature review and personal experience. Part II: loss of maxillary substance (free grafts of autologous bone).

Loss of maxillary substance following trauma varies significantly in relation to the dimensions, site and type of tissue involved. Anatomical maxillary interruptions, loss of dental elements and consequent bone re-absorption give rise to altered chewing, swallowing and speech functions. Treatment of pathological conditions over the years has seen the development of surgical protocols designed to achieve simultaneous aesthetic and functional restoration of the stomatognatic apparatus. The advent of osteointegrated implantology and continual progress in pre-prosthesis surgical techniques have undoubtedly revolutionised established approaches to prosthetic rehabilitation by introducing the concept of supported implant prostheses. The implantation protocols used are a safe and reproducible treatment method suitable for adequate anchorage of such prosthetic implants; the application of such protocols in any case is subordinated to the presence of adequate morpho-volumetric bone at the skeletal bases. Depending on the entity of maxillary loss of substance, the reconstruction methods we propose, in agreement with numerous other authors, are based on the use of free and free-revascularised autologous bone grafts or, even more recently, the application of osteogenetic distraction techniques. The purpose of this article is to evaluate treatment of loss of maxillary substance following trauma by means of non-revascularised free flaps. The use of free grafts of autologous bone is elective in patients presenting bone deficits less than 6 cm with and/or without upkeep of maxillary and mandibular cortical bone continuity but without compromise to the integrity and trophism of the soft tissues.

Pre-eclampsia and peripartum cardiomyopathy in molar pregnancy: clinical implication for maternally imprinted genes.

Molar pregnancies are associated with increased maternal complications, notably pre-eclampsia, but peripartum cardiomyopathy has been rarely observed. Here we report on a 34-year-old woman, gravida 2 para 1, who presented to our obstetric clinic for routine screening at 16 weeks of gestation. Elevated maternal serum alpha-fetoprotein and free beta-human chorionic gonadotropin were observed. Amniocentesis revealed a triploid constitution (69,XXX) and ultrasound examination showed growth restriction, fetal anomalies, placentomegaly and a total placenta previa. On admission at 18 weeks' gestation, the patient developed vaginal bleeding and pre-eclampsia. She underwent a Cesarean delivery and 6 h later developed congestive heart failure requiring intensive care support. Molecular analysis of the conceptus and parental DNA demonstrated an excess of paternal genomic contribution. The over-representation of the paternal chromosome complement may support the role of genomic imprinting in the clinical course of this case.

Severe bronchial synechia after removal of a long-standing bronchial foreign body: a case report to support control bronchoscopy.

The authors report the case of a child who had severe bronchial synechia of the left main bronchus after removal of a pistachio shell embedded in granulation tissue. Histology finding of the removed granulation tissue at initial bronchoscopy showed an Actinomyces bacterial invasion. It was decided not to treat this local contamination and to perform a control bronchoscopy to verify the disappearance of local bacterial invasion. The control bonchoscopy performed 4 weeks after the foreign body (FB) removal disclosed a large central left main bronchus synechia producing a 70% reduction of the lumen, although the child had become asymptomatic except for a slight residual cough. The resection of the synechia restored a normal bronchial lumen. The performance of a systematic control bronchoscopy after removal of long standing FB is discussed and recommended.

Fractures of the iliac crest following anterior and posterior bone graft harvesting. Review of the literature and case presentation.

Iliac crest is the most commonly used extra-oral donor site of autologous non-vascularized bone, because of the great amount of bone available and easy access. Bone grafting from the ileum, however, is not without complications. An extensive review of the literature focusing on fractures of the iliac crest and pelvic ring instability due to anterior and posterior bone graft harvesting is reported, and 1 case of anterior stress fracture of the iliac crest is described. Thirty-five of the 37 fractures described up to date in literature were divided in 2 groups depending on the region of bone graft harvesting. Twenty-four fractures - including our case - were related to bone graft harvesting from the anterior region, 12 were due to harvesting from the posterior region. Four out of 24 anterior fractures required further surgical treatment (16.6%). In 8 of the 12 fractures with pelvic ring instability due to posterior bone harvesting, 1 or more additional surgical procedures were performed in order to stabilize multiple fracture sites (66.6%). Anterior iliac crest fractures, even though painful, remain stable and heal spontaneously in most cases without further complications. On the contrary, fractures due to posterior iliac crest harvestings very often require complex surgical treatments and lead to significant disability, which can be permanent.

Primary high-grade mucoepidermoid carcinoma of the minor salivary glands with cutaneous metastases at diagnosis.

Mucoepidermoid carcinoma (MEC) represents 15% of all salivary glands malignancies. Metastatic disease at diagnosis is observed in less than 5% of the cases. The lung is the most commonly involved site. This is the first reported case of high-grade MEC of the salivary gland with skin metastases at diagnosis. This feature was associated with a chemoresistant and aggressive behaviour. Differential diagnosis between metastatic MEC and primary skin MEC is essential for therapeutic management and prognosis.

Retrospective evaluation on the surgical treatment of jaw bones ameloblastic lesions. Experience with 20 clinical cases.

BACKGROUND: Ameloblastoma is a benign but locally aggressive neoplasm of the odontogenic epithelium that causes expansion of the bone and tends to recur. The aim of this article is to present a retrospective evaluation on the management of ameloblastic lesion of the jawbones and to compare them with those reported in literature in order to rule out which surgical approach is likely to be the most appropriate, considering it extremely controversial. METHODS: Data corresponding to 20 patients with ameloblastic lesions involving the maxillary bones, admitted to the O ral and MaxilloFacial Surgery Department of Verona University Hospital, were analyzed in the period between 1984 and 1999. All data were selected for sex, age, site of involvement, histological patterns of the lesions, surgical steps performed concerning both primary pathology and secondary relapses including the reconstructive methods employed. RESULTS: The results showed a male/female ratio of 1.5/1. All the affected patients showed endosseous tumour masses localized in 90% of the cases at the mandible and only in 10% at the maxillary bone. Only one case with soft tissue involvement was observed. Treatment was enucleation and bone courettage in the 65% of cases while in 35% the lesion was excised performing wide bone resection. The histopathological study on the surgical specimens revealed the 50% of the lesions were unicystic 45% were multicystic showing the other 5% a carcinomatous ameloblastic patterns. The recurrence rate in patients managed with enucleation and courettage was 28.57% while in wide bone resection none recurrence was observed. CONCLUSIONS: Simply enucleation and curettage of multicystic ameloblastic lesion of jawbones results in an unacceptable recurrence rate. Conservative surgical treatment should be considered only in presence of unicystic lesion when extraosseous spread has not occurred. Multicystic lesions should be treated with an extended surgical resection.

[Facial localized cosmetic filling by multiple injections of fat stored at -30 degrees C. Techniques, clinial follow-up of 99 patients and histological examination of 10 patients]. / Comblement localisé facial à visée esthétique par injections multiples de tissu graisseux conservé à -30 degrees C. Technique, suivi clinique de 99 patients et histologique chez dix patients.

At the end of the 1980's and at the beginning of the 1990's, free fat autografts were abandoned because of the poor long-term results. Two theories supported by hystological studies (the host replacement theory or the cell survival theory) have now been proposed to explain survival of fat tissue. They demonstrate that, when harvested by a correct technique, fat tissue presents the ideal characteristics to be grafted, providing a good soft-tissue substitute with a minimum follow-up of four years up to 6 years. The authors present a multiple stage lipofilling technique in 99 cases of facial rejuvenation by means of lipolayering. Injections are performed every 20 days and fat is stored fat at -30 degrees C with good aesthetic results and minimal morbidity with clinical follow-up at 4 and 6 years. Histological examination of fat stored for 20 days and for 8 months was also performed in 10 patients. Microscopic and ultrastructural examination demonstrated that stored adipocytes retain their anatomical features and, when injected in multiple stages, are adequate to obtain good clinical results. Our histological study combined with the clinical outcomes, suggests the advantage of several stage injection of stored fat (-30 degrees C).

[Malignant maxillary tumors involving the pterygo-maxillary and infratemporal fossae: a series of 65 patients and a comparison of the 1997 and 1977 UICC-AJCC staging systems]. / Tumori maligni del mascellare estesi alla fossa pterigo-mascellare ed infratemporale. Risultati su 65 pazienti e confronto fra la classificazione TNM UICC-AJCC 1987 e 1997.

The prognosis for maxillary malignancies with posterior extension to the pterygo-maxillary and infratemporal fossae is worse than for those with anterior-inferior extrinsication. Maxillectomy using only an anterior approach does not enable enblock, radical resection of such tumors. Many different approaches to the infratemporal fossae have been described in the literature. The authors use a double infratemporal and transfacial approach. Between 1990 and 1998 this approach was used on 65 patients with malignant maxillary tumors. There was one post-operative death due to myocardial infarction. There were only 9 cases of temporal infection, and all were resolved. There were no cases of necrosis of either the temporal muscle or the revascularized flaps. The cases included the following tumors: spinocellular and anaplastic carcinoma (21 cases); adenoid-cystic carcinoma (16); adenocarcinoma (4); sarcoma (18); other malignant tumors (6). There were 29 primary tumors while the remaining 36 were recurrences from prior treatment. Using the UICC-AICC 1987-92 staging system there were 22 cases of T3 and 43 T4. Using the 1997 system there were 35 T3s and 30 T4s. Resection was radical in 54 cases while in the remaining 11 there were micro or macroscopic limitations at the rhinopharyngeal level and/or at the orbit apex. The NED survival percentages were: T3 59.2%; T4 28% (using the 1987-92 system) while they were T3 45.7% and T4 26.7% (using the 1997 system). In the 41 patients with carcinoma (spinocellular, anaplastic, adeno and adenoid-cystic) the NED survival percentages were: T3 54.5%; T4 23.4% (using the 1987-92 system) while they were T3 45% and T4 19% (using the 1997 system). The NED survival percentage was 41.4% for primary tumors and 36.1% for recurrences. These results lead one to conclude that this surgical technique permits good results with T3-T4 maxillary malignancies. The prognosis for recurrences is worse than for primary tumors and the prognosis for sarcoma is better than for carcinoma. The UICC-AICC staging systems are valid for prognostic purposes. The current analyses indicate that the 1987-92 system is slightly more suitable than the 1997 system. In fact, there were 13 patients which the 1987-92 system had classified as T4 and which the 1997 system had reclassified as T3. In all these cases the prognosis was more similar to that of T4 than T3.

Primary non-Hodgkin's lymphoma of the jaws: immunohistochemical and genetic review of 10 cases.

PURPOSE: Non-Hodgkin's lymphoma (NHL) comprises a group of malignant lymphoproliferative diseases characterized by clonal expansion of lymphocytes at various levels of ontogenetic development. The aim of this study was to review the immunohistochemical and cytogenetic features of 10 cases of NLH of the jaws to determine their respective derivation. PATIENTS AND METHODS: Histopathologic and immunohistochemical review of 10 cases of large-cell lymphomas of the jaws, together with Southern blot analysis of 2 of the cases, was performed and results compared with the findings in the literature. RESULTS: In the 10 cases studied, the average age of onset of the NHL was 51 years, with a male-to-female ratio of 3:2. Tumefaction was the first clinical sign of disease. Eight of 10 cases were high-grade, large-cell NHLs, centroblastic type. Two cases were high-grade, large-cell NHL, immunoblastic type. CONCLUSION: The immunohistochemical and Southern blot data remain the principal laboratory aids in the diagnosis and characterization of NHL, and they provide critical information for guiding clinicians to the appropriate treatment protocol for these malignancies.

Implant placement in the maxillary tuberosity: the Summers' technique performed with modified osteotomes.

The maxillary tuberosity region is becoming increasingly involved in preprosthetic surgery as part of a comprehensive implant treatment planning. The lower success rates in osteointegrated implant placements seen in the posterior regions of the upper maxilla as compared to the anterior regions of the jaws, most often come from bone quality types and the presence of the maxillary sinus. In order to overcome these limitations and obtain a successful result in such a demanding area, several authors suggest that long implants (15.0 to 20.0 mm long) should be placed in the maxillary tuberosity region as an alternative to sinus floor elevation. The challenges frequently associated with the surgical placement of "maxillary tuberosity implants" (MTI), can be reduced through a "Ridge Expansion Osteotomy" (REO) procedure as described by Summers (1994). This indeed improves the recipient bed bone quality and causes no bone overheating. In order to improve this technique performed for MTI, in co-operation with Ing. Albanese G, authors have developed different prototypes of modified osteotomes. A case report using these new instruments is presented. Clinical and radiographic evaluations are obtained.

[Intraoperative lesions of the maxillary artery and its immediate treatment. Presentation of a clinical case]. / Lesione intraoperatoria dell'arteria mascellare e suo immediato trattamento. Presentazione di un caso clinico.

The authors discuss the possible vascular lesions that may occur during mandibular sagittal split ramus osteotomies with particular regard to the maxillary artery. A case of surgical lesion of the maxillary artery is presented and its course and anastomoses are analyzed. The ligation of the external carotid artery and its principal branches is the treatment of choice in case of maxillary artery lesion which is a life threatening event and needs immediate intervention.