Right leg swelling as primary presentation of metastatic Merkel cell carcinoma.

Merkel cell carcinoma (MCC) is a rare malignant cutaneous neuroendocrine tumour with an aggressive behaviour and frequent regional lymph node and distant metastases. It mostly occurs in old patients and the commonest sites are the skin of the head, neck and the extremities. Typically, the primary tumour presents as a fast-growing, painless, reddish nodule with an iceberg-like effect, broadening in the depth. Although the pathogenesis of MCC remains largely unknown, ultraviolet radiation and immunosuppression are likely to play a significant pathogenetic role. The authors describe an unusual case of MCC clinically presenting as lymphedema on the right leg due to an inguinal lymphonodal metastasis. Although extensive investigations were performed the authors were unable to discover the cutaneous primary tumor. The authors examine the etiopathogenesis and hypothesis of this rare tumour and describe the clinical differential diagnosis. They suggest that clinical features together with imaging studies and morphological and immuno-histochemical findings are important for the correct diagnosis.

Cognitive and affective assessment and multiple pathologies in institutionalized elderly.

Studies were carried out using the mini mental state examination (MMSE) and the geriatric depression scale (GDS) in 71 elderly patients, in order to establish eventual correlations between cognitive deficit, depression and multiple pathologies. This examination was part of a multidimensional evaluation involving patients over 65 years of age hospitalized in the Department of Clinical Medicine. The patients were divided into 5 grades on the basis of the extent ot functional impairments (from Grade 0 to Grade IV) (British Columbia Classification). Mean MMSE and GDS scores, as well as the mean of the multiple pathologies were calculated in each group. As all the MMSE items could not always be applied, we used a score obtained by dividing the maximum score accomplished by the maximum score applicable. No MMSb impairment was present in 94.11% of the Grade 0 patients, in 57.14% of the Grade I, in 37.5% of the Grade II, and in 40% of the Grade III patients. However, impairment was present in all the Grade IV patients. GDS analysis revealed no depression in 82.35% of Grade 0 patients, in 21.43% Grade I, in 50% Grade II, in 16% Grade III patients. However, some degree of depression was present in all Grade IV patients. The occurrence of patients affected by multiple pathologies was as follows: 1-2 pathologies were recorded in 47.06% of Grade 0 patients, in 57.14% Grade I, in 37.5% Grade II, in 36% Grade III, and in 57.14% of Grade IV patients.

Multiple pathologies and drug consumption in a group of centenarians from Eastern Sicily.

Multiple pathologies are characteristic for the elderly. We evaluated the prevalence of multiple pathologies in 28 randomly selected centenarians living in Eastern Sicily and compared the data with those obtained in another random group of 28 control subjects over 80 years of age. It has been revealed that 25% of the centenarians suffered from 0-3 pathologies, while the remaining 75% displayed more than 3 pathologies. The control subjects had 0-3 pathologies in 50% of over 80 years, while 50% were affected by more than 3 pathologies. In centenarians the most prevalent pathologies involved the sensorial apparatus (sight and hearing), followed by the digestive, urogenital and cardiovascular systems. In the control group the rank of occurrence was as follows: cardiovascular system, osteoarticular and respiratory apparatuses, and sensorium. We compared drug consumption in the two age groups. In the centenarians, 71.43% took 0-3 drugs, while 28.57% took more than 3 drugs. In the control group, 53.57% took 0-3 drugs, whereas 46.43% took more than 3 drugs.

Study on the sense of taste in a group of Sicilian centenarians.

The sense of taste was studied in a group of 20 centenarians from Eastern Sicily, displaying a mini mental state examination (MMSE) score higher than 19. Control subjects were 20 adult (mean age 27.7 +/- 3.2 years) and 20 elderly subjects (mean age 71.3 +/- 5.5 years). Although it has been revealed that centenarians retain considerably the capacity to perceive tastes, they displayed statistically significant reductions (p < 0.001) in taste functions for sweet, sour, salty and bitter, as compared to both the adult and elderly controls.