The objectives of this study were two-fold: to identify tear histamine content and its relationship to changes in tear histaminase activity during the early (EPR) and late phases (LPR) of the allergic reaction induced by a conjunctival provocation test (CPT) and to evaluate the effects of lodoxamide on histamine release and allergic signs and symptoms during EPR and LPR. A baseline CPT was administered to 20 allergic patients with no baseline signs or symptoms of allergy. Clinical signs and symptoms were evaluated after 20 minutes and 6 hours. Tear samples were taken after 5-10 minutes and after 6 hours for subsequent analyses of cytology and histamine content (ELISA). Patients were then randomly assigned to receive lodoxamide or placebo four times daily for one week in a double-masked fashion. A second CPT was done after this therapy and the same parameters were re-evaluated. During EPR, tear histamine increased significantly with respect to baseline values (p < 0.05). During LPR, tear histamine increased significantly (p < 0.05) only in histamine inactivated samples. Histaminase enzymes were also significantly less active during the EPR (5.5 +/- 0.7) than the LPR (9.9 +/- 2.3) and at baseline. Histamine levels significantly correlated with allergic signs and symptoms (p < 0.05) only during the EPR. Lodoxamide significantly reduced histamine release during EPR (p < 0.05), allergic signs and symptoms during both EPR (p < 0.001) and LPR (p < 0.005), and tear cytology counts during LPR. In conclusion, greater histaminase activity may account for the smaller amount of tear histamine generally found during LPR, while these enzymes seem to play less of a role during the surge of histamine release and activity in the EPR. Lodoxamide was shown to ideally inhibit various aspects of the allergic reaction: clinical signs and symptoms in both the early and late phases, the primarily EPR-related peak of histamine release, and the primarily LPR-related changes in tear cytology.

Abstract. Rates of recurrence after incomplete surgical excision of basal cell carcinoma (BCC) range from 4 to 16.6% of analyzed cases. The aim of the present study was to identify the predictive factors associated with facial BBC recurrence following excision and their influences, in order to establish a proper therapeutic strategy. A monocentric retrospective study was performed reviewing all BCCs surgically excised at the Institute of Plastic Surgery, University of Padua, with particular focus on the involvement of surgical margins and recurrence. Seven hundred and nineteen lesions in 605 patients were studied. Correlations between recurrence probability and various characteristics of BCC were analyzed using a logistic regression model. It was observed that incomplete excision, deep margin involvement, the presence of sclerodermiform or metatypic basaloid squamous cells, as well as pleomorphous histological variants and/or peritumoral inflammatory infiltrates, were all related to an increase in the probability of recurrence. BCC excision must be followed by individualized management with particular consideration for the localization, the histological type and other known predisposing factors; the treatment strategy and, in particular, the length of the surveillance period and the frequency of patient assessment should be evaluated on the basis of the recurrence probability outlined.

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