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Actinomycosis is an uncommon chronic granulomatous infection that cause formation of abscesses and cutaneous fistula. In mandibular actinomycosis the alveolar bone and mandibular body are usually not involved and the pathogenetic mechanisms of the actinomycotic infiltration is unknown. The patients usually report pain at the alveolar arch with development of a purplish-red swelling firmly attached to the mandibula; the fibrous tissue produces the continued development of new cutaneous fistulas with oncoming pus-secretion. An uncommon case of actinomycotic osteomyelitis with a double pathological fracture of mandibula is reported. Ortopanoramic X-ray and computed tomography scan of the mandibula are effective and relevant diagnostic procedures to quantify the entity and site of the osteolitic areas and to define the precise position of fractures. In association with the intravenous infusion of benzilpenicillina, daily local irrigations of rifamicina have been performed. Moreover, the patient underwent surgical drainage of abscesses with accurate curettage of osteomyelitic lesions and several biopsies of the trabecolar bone and fistulas were taken. It has been also necessary to perform a mandibular blockage using a resinal plaque anchored on premolars. To reach a precise diagnosis, an histopathological examination togheter with batterioscopic-coltural examination is needed. Antibiotic therapy alone is not a sufficient therapeutic approach and surgical treatment must be quickly performed with clean up of the osteomyelitic lesions and contention of fractures by alveolar blockage for at least 40 days.

One-hundred seventy four consecutive patients who underwent curative resection for gastric and colorectal cancer between 1983 and 1985, were studied prospectively to evaluate the roles of sequential CEA, TPA and GICA determinations and independent clinical examinations, in the early diagnosis of resectable recurrences. Sixty-six recurrences (33 from gastric and 33 from colorectal cancer) were detected between 6 and 42 months after primary surgery. In gastric cancer CEA, TPA and GICA showed a sensitivity of 64%, 73%, and 60%, and a specificity of 67%, 65% and 54% respectively. Nine patients (27%) underwent surgical treatment for the recurrent disease, and 4 of them (44.4%) had resectable recurrence, for a total resectability rate of 12%. Out of these four patients, three patients are still living after 12, 36 and 44 months respectively from re-operation without evidence of neoplastic disease. In one of these patients re-operation was performed on the basis of the elevation of the three markers, without any other clinical sign of disease, this patient had a resectable solitary hepatic recurrence. In colorectal cancer CEA, TPA and GICA showed a sensitivity of 73%, 73%, and 49%, and a specificity of 77%, 87%, and 97% respectively. Fourteen patients (42.4%) underwent surgical treatment for the recurrent disease, and 8 of them (57%) showed a resectable recurrence, for a total resectability rate of 24.2%. Six patients are still living after 9, 16, 21, 31, 41 and 53 months respectively from reoperation without evidence of neoplastic disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Two cases of fibroelastoma of the back are reported. It is pointed out that probability diagnosis in mainly entrusted to the objective examination and to the typical site of tumefaction, backed by echotomography, xeroradiography and computerised tomography and demonstrated by histological examination of the operative piece. Differential diagnosis has to be established versus fibrosarcoma, liposarcoma, desmoid tumour and malignant tumour of the synovia. The need for surgical removal is reiterated.