A bilateral cornual uterine dehiscence is reported, which occurred 14 weeks after in-vitro fertilization (IVF) in a patient having a medical history of previous bilateral salpingectomy via laparoscopy. Uterine rupture is a rare obstetric complication usually occurring during the third trimester of pregnancy within a uterus which has previously undergone an operation. Ectopic pregnancy is a well known complication of IVF. Post-salpingectomy cornual localization with rupture has also been published. Possible causes are discussed and the attention of the counselling physician is directed to the necessary awareness of such a complication in this high risk population. The reported case is an extreme rarity: a similar case has not been previously published in the literature.

No abstract

Poly(adenosine diphosphate-ribose) polymerases (PARPs) are a family of enzymes, which catalyses poly (ADP-ribosyl)ation of DNA-binding proteins and directly involved in genomic stability, DNA repair, and apoptosis. In this study, we evaluated the immunomorphology of PARP-1 in melanoma and its prognostic importance. We studied PARP-1 expression by immunohistochemistry in a selected series of 54 primary cutaneous malignant melanoma (CMM). The findings of the present study suggest that the neoplastic progression toward the invasive (both horizontal and vertical) growth phase of CMM cells is characterized by the loss of cleavage of PARP-1, probably signaling an imbalance of the apoptotic process in these cells and leading to further gain to aggression. Over-expression of full-length PARP-1 was correlated with recurrence and/or progression of the disease and so act as a promising new biological marker of CMM. Our study represents the evidence of a direct correlation between the PARP-1-mediated apoptotic process and the biologic behavior of CMM.

No abstract

A melanoma malignum kezelésében a korábbi mechanikus szemléletet felváltotta az ún. biológiai szemlélet, melynek során a szervezet tumorellenes mechanizmusait igyek szünk támogatni. Ez a szemléletváltás a melanoma sebészeti kezelésben a primer tumor körüli biztonsági zóna lecsökkentéséhez és az őrszem (sentinel) nyirokcsomó biopszia bevezetéséhez vezetett. A melanoma terápiájában manapság a sebészre négy meghatározó feladat hárul: a primer tumor eltávolítása, sentinel nyirokcsomó biopszia valamint blokkdisszekció elvégzése és a bőrmetasztázisok sebészi ellátása. Jelen összefoglaló közleményben a szerzők a legfrissebb nemzetközi irányelvek, tudományos eredmények és saját gyakorlatuk alapján részletes áttekintést nyújtanak a melanoma műtéti ellátásáról, beszámolnak a nem rezekábilis bőráttétek kezelésében hasz nálatos új eljárásról, a hazánkban is elérhető elektrokemoterápiáról. Kulcsszavak: melanoma malignum-biztonsági zónasentinel nyirokcsomó-blokkdisszekció-elektrokemoterápia SUMMARY Recently the biological approach dominates in the treatment of malignant melanoma, which means the support of the antitumor defense of the organism. This view has led to diminished safety margins at the removal of the primary tumor and introduction of sentinel lymph node biopsy. Nowadays surgeons have four main tasks in the treatment of melanoma: excision of primary tumor, sentinel lymph node biopsy, regional lymph node dissection, and surgical treatment of the metastases. Based on the latest international guidelines, published data, and best practices authors summarize the current surgical therapies of cutaneous malignant melanoma, and also account on electrochemotherapy, which is a new, effective treatment of the irresecable cutaneous metastases.

Early diagnosis and complete removal of the malignant cells are of paramount importance in the treatment of malignant melanoma. This usually requires a two-step approach. First, pigmented or amelanotic lesions suspicious for melanoma should be promptly biopsied and submitted to pathological evaluation, and second, the tumor should be subsequently excised with adequate surgical margins. The margins of the final excision are determined with the tumor characteristics in mind, as determined by the histopathological analysis of the biopsy specimen. Thus, removal of appropriate biopsy sample containing the fragment with the worst prognostic characteristics, is of substantial importance. As extensive loss of tissues may potentially influence the feasibility of further surgical interventions, such as the sentinel lymph node biopsy, the use of proper biopsy techniques is essential during the primary treatment of melanoma. Recommendations regarding the width of the surgical margin of excision are nowadays clearly defined for primary melanoma, and are based on the histopathological features of the melanoma. These recommendations, however, are sometimes difficult or impossible to follow, like in the case of specially localized melanomas, or certain melanoma subtypes. This chapter summarizes the available evidence regarding different biopsy techniques and the surgical management of primary melanoma. 2.1. Biopsy of melanoma suspect lesions The primary aim of performing biopsy in the case of a melanoma suspect lesion is to establish or exclude the diagnosis of melanoma. An additional goal is to ensure accurate pathological staging of the tumor in order to enable adequate surgical management by performing wide local excision (WLE). Excisional, incisional and shave biopsy techniques are used in the surgical treatment of melanoma. 2.1.1. Excisional biopsy The preferred biopsy technique for most melanomas is excisional biopsy.[1,2] This means that the entire lesion is removed with an additional 1-3 mm margin of normal-appearing skin. Wider excisions, however, should be avoided, to permit subsequent lymphatic mapping for sentinel lymph node biopsy. Generally, the excised tissue sample should contain part of the subcutaneous fat as well, and should be oriented to aid subsequent histopathological evaluation. The positioning of the excision also should possibly allow for subsequent wider excisions. The excisional biopsy technique can be used in most melanomas, when primary closure of the wound is feasible. Although the lowest frequency of positive margins is reported when excisional biopsy is used, positive margins and even residual melanoma on WLE do occur.[3] 2.1.2. Incisional biopsy The reported frequency of excisional biopsy technique used for diagnosing melanoma varies significantly with centers, countries, and individuals, and ranges between 10 and 86 percent.

These data confirm the importance of skin cancer surveillance in transplant recipients via a close cooperation between Transplantation and Dermatological Centres. Our results reflect the international data, except for the BCC : SCC ratio. Further studies needed to elucidate this difference.

Objectives: In Italy, standard treatment care of patients with neovascular ("wet") age-related macular degeneration (wAMD) is currently performed with ranibizumab (RBZ) on as-needed basis (PRN). The objective of this study was to assess the cost-effectiveness of intravitreal aflibercept (IVT-AFL), administered every other month vs. RBZ PRN treatment, in the Italian treatment setting. MethOds: A Markov model was built to compare IVT-AFL compared to RBZ PRN in wAMD. Health states were based on visual acuity in the better-seeing eye. In the model, patients may remain in the same status (same visual acuity), progress to another status or die. A proportion of patients may also discontinue treatment monthly or upon becoming blind. Parameters were estimated from two randomized phase III studies VIEW 1/VIEW 2, published literature or expert opinions. Analyses were performed from the Italian Healthcare perspective, using a 20-year time horizon (starting age was 77 years). The simulation model calculated costs (drug, administration, monitoring, vision impairment and adverse events), qualityadjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), all discounted at 3% annually. Deterministic and probabilistic sensitivity analyses (SA) were performed to test the robustness of the results. Results: IVT-AFL costs 30,852€ compared with 33,636€ for RBZ PRN; QALYs totaled 2.651 for IVT-AFL and 2.638 for RBZ-PRN respectively. IVT-AFL is associated with less cost and more QALYs gained than RBZ-PRN and hence dominates RBZ PRN. Deterministic SA showed that the results were most sensitive to changes in efficacy and time horizon, while probabilistic SA showed that 90% of the iterations fell within the cost-effectiveness threshold deemed acceptable for Italian Payers (for example € 40,000). cOnclusiOns: Results indicate that, within the Italian treatment setting, attainment of maximal visual gains via IVT-AFL is cost-saving that means less costly and more effective (more QALYs gained) compared to RBZ PRN.