Risk factors for positive sentinel lymph node, lymphatic or hematogenous dissemination over time in patients with cutaneous melanoma

The aim of the present study was to assess the influence of localization, age or sex and histopathological characteristics upon the chance of developing lymphatic or hematogenous metastatic spread over time, or a positive sentinel lymph node in cutaneous melanoma patients. Patients from the Department of Dermatology, County Emergency Hospital Cluj-Napoca (Cluj-Napoca, Romania), presenting with cutaneous melanoma confirmed histopathologically and a SPECT/CT or lymphoscintigraphic examination to detect the sentinel lymph node, were included in the present study. Our results revealed that Breslow index >2 mm [odds ratio (OR)=4.22, 95% confidence interval (CI) (1.12; 15.93)], presence of ulceration [OR=6.01, 95% CI (1.87; 19.35)], and positive sentinel lymph node [for at least one sentinel lymph node OR=3.58, 95% CI (1.06; 12.04)] were risk factors for hematogenous metastases. All these, except for the Breslow index >2 mm, were demonstrated to be a risk factor for lymphatic spread metastases over time. Ulceration and male sex also represented risk factors for a positive sentinel lymph node, men having a higher risk of developing sentinel lymph nodes than women [adjusted OR=2.27, 95% CI (1.00; 5.13)]. In conclusion, the predictors that influence the occurrence of lymphatic or hematogenous metastases may differ, ulceration and positive sentinel lymph node being common for both types of metastatic spread, while Breslow index being a significant predictor only for hematogenous metastases. Male sex and the presence of ulceration were demonstrated to be significant risk factors for positive sentinel lymph nodes.

The Vogt-Koyanagi-Harada and SAPHO Syndrome: An Unusual Association

Vogt-Koyanagi-Harada syndrome(VKH) is a multisystemic disorder characterized by granulomatous panuveitis and cutaneous, otorhynolaryngologic and neurologic involvement, due to an autoimmune reaction against melanocytic antigens. Autoinflammatory associations of VKH, including inflammatory bowel disease and psoriasis, were rarely described. SAPHO syndrome (an acronym for synovitis, acne, hyperostosis, pustulosis and osteitis) is a rare autoinflammatorymusculo-scheletal disease. This paper reports on a male patient presenting for long-lasting bone and joint pain, dysphagia,having a ten-year history of bilateral optic neuritiswhich required high-dose corticosteroids. Fundoscopy revealed diffuse chorioretinalnonpigmented atrophic lesions. Vitiligo, acne scars, clavicular deformity, recurrent chest pain and sacroiliitis pointed to a long-standing SAPHO syndrome and late-phase VKH. Blood tests found inflammation and anti-hepatitis C antibodies with repeatedly undetectable viremia. Bone scintigraphy with the characteristic bull�s head upper chest uptake and the radiographs confirmed SAPHO syndrome. The patient was treated with sulphasalazine and cyclosporin A, with alleviation of the articular and bony disease. In conclusion, SAPHO syndrome may add to the list of the diseases associated with VKH. Although VKH and SAPHO syndrome may have appeared coincidentally, a common pathogenesis involving an infectious trigger and IL-17 could be considered.

Ultrasonography contribution in detection of reno-urinary anomalies: a cohort study

AIMS

The current study aims to assess the role of ultrasound (US) parameters in explaining the variance of hydronephrosis grades in reno-urinary anomalies, as well as their performance in quantifying the incidence of patients with uropathies.

METHODS

In this study 196 patients were prospectively included. All of them had renal/urinary tract anomalies and were recruited from 5992 US examined hospitalized patients. Fifty patients were referred also to renal 99mTc- DMSA or 99mTc-DTPA scintigraphy. The diagnostic performance of renal ultrasound and scintigrafy parameters was assessed.

RESULTS

Pelvis antero-posterior diameter (APD) values were strongly correlated with other investigated parameters. They correlated with measurements of US parenchyma values (r=0.59, p=0.001), pelvis area (r=0.76, p=0.001) and with scintigraphy long axis measurements (r=0.89, p=0.001). In multiple regression analysis, the pelvis APD is the only independent predictor of high grades hydronephrosis (p=0.001) and explained 62.4% of the variance of hydronephrosis grades. The cut-off values for detection of significant hydronephrosis (grades 3,4) was 11 mm or more, and for detection of severe, in need of surgery, hydronephrosis was 19 mm or more.

CONCLUSIONS

The diagnostic performance of ultrasound was good, similar to those previously published by other authors. US detected pelvis APD is the main predictor for high grades hydronephrosis but other parameters also influence the uropathy grades.

Scintigraphic detection and localization of gastrointestinal bleeding

By frequency and often through the difficulties of diagnosis and treatment, gastrointestinal (GI) bleeding plays an important role in the activity of medico-surgical departments. Successful management of patient with GI bleeding depends on accurate localization of the bleeding site. The early etiological diagnosis of GI bleeding is important for the early optimal treatment (medical or surgical). In addition to the clinical exams, endoscopy and angiography may be used as invasive methods to localize the bleeding site. Beside these, the isotopic technique in detecting GI bleeding is non invasive, rapid and with high sensitivity. Correctly indicated and performed, the imaging methods, invasive or not, play an important role in the success of treatment. For the clinicians it is important to know the best algorithm of examination and the role of each technique and, bearing in mind the technical equipment of the hospital to use quickly the appropriate method rapidly.