Extraocular sebaceous carcinoma in Muirr Torre Syndrome with unfavorable prognosis.
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Adult↗
Biomedical subjects
N Scuderi
Publications and source records attributed to N Scuderi.
The use of laser and Varioscope in the management of hemangiomas and vascular malformations.
Vascular lesions are common in infants and children and can be grouped into two main classifications: vascular tumors and vascular malformations. Hemangiomas are proliferative lesions characterized by increased endothelial cell turnover. Vascular malformations are congenital abnormalities involving capillaries, veins and/or lymphatics. A multidisciplinary approach regarding diagnosis and treatment of vascular anomalies in children is crucial. Several options are available for the treatment of hemangiomas. Since January 2003, 14 cases of hemangioma located in the cervicofacial region were treated at "La Sapienza" University. Seven patients underwent surgical resection, using Varioscope, and seven laser therapy. The Varioscope is an operating microscope, which is mounted on the head. Specific advantages convinced the authors to use the Varioscope initially. Autofocus, a magnification range between 3.6-7.2X and automatic parallax control allow unlimited freedom of movement which alleviates the discomfort of keeping the same distance for a long time. Laser therapy can selectively destroy specific targets within the skin by using an appropriate wavelength and pulse duration. Laser treatment parameters are based on several factors, including lesion location, lesion morphology, and patient skin type. The purpose of our study was aesthetic and functional improvement in patients comparing surgical and laser therapy. We obtained an aesthetic improvement in 11 patients and local pain control in all patients. Analysis of the cosmetic results was subjective but all parents indicated satisfaction with their decision regarding their child's treatment.
Arteriovenous Malformations↗
Lateral canthoplasty--10-year experience.
Lateral canthoplasty is a useful method to restore eyelid function and to protect the ocular surfaces. The success of the procedure depends on the proper analysis of periorbital anatomy as it relates to the specific indication for lateral canthoplasty. We report the experience with 129 lateral canthoplasties with emphasis on the evaluation of newer techniques that better address anatomic and functional requirements. Between 1994 and 2004, 129 lateral canthoplasties were performed in 105 patients, only for reconstructive purpose. A variety of surgical techniques have been described for lateral canthoplasty, and the evolution of the operative technique for lateral canthoplasty has been toward an operation that corresponds with the anatomy of the individual. Indications for the procedure include senile ectropion, tumors, cicatritial retraction, trauma, entropion, and congenital cleft. The evaluation of the newer procedures of lateral canthoplasty as unique reconstructive tools will be discussed.
Blepharoplasty↗
T-cell lymphoma presenting as a rapidly enlarging tumor on the lower eyelid.
Lymphoma or leukemia skin lesions as a secondary site of disease are quite common; however, to discover a cutaneous Hodgkin or non-Hodgkin lymphoma is very unusual. To find a cutaneous T-cell lymphoma on the skin of the face is a rarity. Because the condition is so rare and difficult to diagnose and treat, we report the case of a young man with a T-cell lymphoma with atypical and anaplastic cells on the lower eyelid. The patient was treated with 4 cycles of chemotherapy, and radiotherapy, and the tumor was resolved after 6 weeks. Our case was clinically suggestive of a rapidly enlarging malignant lymphoma on the eyelid. If the lymphomas are detected at an early stage the prognosis for survival is favorable. A few forms of treatment are possible, either surgical treatment, or radiotherapy and chemotherapy, where response to the treatment is better.
Adult↗
[An alternative to the usual operating microscope and loupe magnification for free microvascular tissue transfer. Varioscope AF3-A].
AIM: Free microvascular tissue transfers have become today a key instrument for the surgical treatment of wide loss of tissue, but their employment implies mandatory use of the right visual magnification means. Until now these instruments were mainly loupes and operating microscopes. Our study is focusing on the use of a new visual system--Varioscope AF3-A--in the reconstructive microsurgery field. METHODS: Varioscope AF3-A (Life Optics, Vienna, Austria) has been employed in our Institute in 10 microvascular reconstructions, where different free flaps were used in head and neck reconstruction. RESULTS: All the flaps took and only one developed a partial necrosis. We have also noticed, by using this new instrument, a learning curve with a progressive contraction of the operating time. In all cases we have operated on 2 mm caliber vessels or more and on tissues that didn't previously undergo radiation therapy. CONCLUSIONS: The employment of a visual magnification mean, as Varioscope AF3-A, allows autofocus (from 3.6X to 7.2X) and a wide vision. It can be easily used with substantial advantages for the surgeon in performing microvascular anastomosis. Partial drawbacks are the equipment high cost and weight, compared to the loupes and a stronger ocular stress due to the continuous autofocus compared to the static operating microscopes.
Humans↗
Detection of melanoma cells in sentinel lymph nodes by reverse transcriptase-polymerase chain reaction: prognostic significance.
BACKGROUND: Recently reverse transcriptase-polymerase chain reaction (RT-PCR) has been proposed as a new sensitive method for the detection of submicroscopic melanoma nodal metastases. Sentinel lymph node (SLN) status is considered the most important prognostic factor for melanoma patients. Thus, in recent years, melanoma research has been focused on identifying new molecular markers of micrometastases. METHODS: In this study, 129 SLNs were collected and analyzed by RT-PCR for tyrosinase and melanoma inhibitory activity (MIA) messenger RNA (mRNA) expression. RESULTS from PCR analysis were then compared with those obtained by hematoxylin and eosin and immunohistochemistry and related to progression of disease. RESULTS: MIA gene expression was positive by RT-PCR in 27% of the tyrosinase-positive SLNs. When the correlation between tyrosinase and/or MIA mRNA expression and disease-free survival was evaluated by the Kaplan-Meier exact test, there was a statistically significant correlation between simultaneous tyrosinase and MIA gene expression in SLNs and progression of disease. CONCLUSIONS: RT-PCR analysis for both MIA and tyrosinase mRNA may identify a subset of melanoma patients with a worse prognosis whom the routine methods, such as histology and immunohistochemistry, fail to identify because of the poor sensitivity of these methods.
Disease-Free Survival↗
Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women.
Liposuction is one of the more common elective surgical procedures in the US and is supposed to be on the increase. There are no reported studies specifically addressing the metabolic sequelae of liposuction in obesity. The aim of the present study was to investigate the role of large-volume liposuction on insulin resistance and circulating inflammatory markers in obese people. Thirty healthy premenopausal obese (body mass index (BMI) from 30 to 45) and 30 age-matched normal weight (BMI<25) women were studied. In obese women, insulin sensitivity, as measured by the Homeostasis Model Assessment (HOMA=fasting plasma glucose x fasting serum insulin divided by 25), as well as serum adiponectin, the novel adipocytokine with insulin sensitising properties, were significantly lower, as compared with nonobese women (p<0.01), indicating insulin resistance; on the contrary, serum concentrations of the proinflammatory cytokines IL-6, IL-18 and TNF-alpha, as well as the sensitive marker of inflammation C-reactive protein, were significantly higher (p<0.01). All obese women were submitted to a single large volume liposuction (superwet technique): the mean aspirate volume was 3540 ml (range 2550-4670), corresponding to a net lipid loss of 2.7+/-0.7 kg (mean+/-SD). After six months of stable body weight after liposuction, women were less insulin resistant (p<0.05), had reduced concentrations of IL-6, IL-18, TNF-alpha and CRP (p<0.05-0.02), and increased serum levels of adiponectin (p<0.02) and HDL-cholesterol (p<0.05). There was a significant correlation between the amount of fat aspirate and changes in HOMA (r=0.28, p<0.05), TNF-alpha (r=0.31, p<0.02), and adiponectin (r=-0.34, p<0.02), as well as between the decrease in TNF-alpha and the increase in adiponectin after the surgical procedure (r=-0.45, p<0.01). Our study demonstrates that liposuction is safe and free of metabolic sequelae in obese women, pending a careful screening of the patient. Moreover, it is associated with amelioration of insulin resistance and reduced circulating markers of vascular inflammation which may help obese subjects to reduce their cardiovascular risk.
Adult↗
Breast asymmetry: a new vision of this malformation.
Breast asymmetry is defined as a difference of form, position or volume of the breast and is a pathology affecting over half of the female population (1, 4). Fortunately although it is very frequent, surgical correction is seldom necessary. The authors present the results of the surgical treatment of 73 patients affected with breast asymmetry and they describe the employment of a new instrumental method (SCAN-3D) that may be used both within the correction program and during the follow-up of the surgical treatment. The system involves the use of a laser to scan the surface to be acquired and by the subsequent analysis of the image produced by the overlap of itself with the area under examination, by utilising specific software, we retrieve information regarding both the morphologic and volumetric connections in all three dimensions. The employment of new research methods (Three-dimensional scanning) is an important aid to the aesthetic surgeon, as it allows the study of the mammary glands morpho-volumetric component in relation to the rest of the thorax. Moreover, in the future, the custom production of breast implants, made to measure, and perfectly adaptable to the deformity of each patient may be possible.
Adult↗
Use of polylactic acid in face lipodystrophy in HIV positive patients undergoing treatment with antiretroviral drugs (HAART).
OBJECTIVES: The recent use of antiretroviral drugs in people with HIV infection produced a drastic reduction in mortality and a remarkable improvement in the quality of life for these patients. However the aesthetic and psychological consequences that come from the reorganization of the adipose tissue induced by these drugs (facial wasting, buffalo hump) may reduce this state of wellbeing. METHODS: Our group, in cooperation with the 3rd Division of Infective Diseases of the University of Rome "La Sapienza", decided to evaluate the efficacy of polylactic acid (PLA) in combating these problems in HIV positive patients undergoing treatment with antiretroviral drugs in an evaluating study of 4 cases. The evaluation of the obtained results was performed by follow-up at one, three, six and twelve months from the first infiltration and considering the clinical evaluation, the photographical documentation and the patient's judgement. RESULTS: In all cases we obtained an improvement of the local condition with the restoration of a more booming aspect. The change was noted both within the family and the work environment. In the first three cases the results were considered as optimal by both the operators and the patients. In the fourth case the result was evaluated as discreet (a remarkable loss of weight of the patient in the months following the treatment should be taken into consideration). CONCLUSIONS: We think a new study with ultrasonography of dermal thickness before, during and after the treatment is necesary. This study will give a more reliable evaluation of the product efficacy.
Adult↗
Different types of embolization before surgical excision of haemangiomas of the face.
The management of hemangiomas of the face depends on several clinical factors. Many treatments have been recommended for the management of patients with hemangiomas. However, most of them have not shown good results in terms of post-treatment morphology and function of the organs. Surgery of these benign lesions can at times be disfiguring, especially when the lips, muscles, or the maxilla are involved. In addition, by the very nature of these lesions, surgical treatment may be associated with excessive intra and perioperative blood loss. As an alternative to surgical excision, different types of embolization treatments have been developed for all types of hemangiomas. In many instances the procedure was performed preoperatively or intraoperatively. The various therapeutic embolizations, if performed correctly, lead to a significant reduction in the blood flow within the angiomatous mass. Different types of embolization of the lesions and subsequent surgical extirpation can be considered the method of choice in the treatment of voluminous hemangiomas of the face.
Adult↗
[Free anterolateral thigh flap for reconstruction of head and neck defects: preliminary results and a comparison with the radial forearm flap].
BACKGROUND: The authors present their personal preliminary experience with the free anterolateral thigh flap in the reconstruction of head and neck defects and compare these first cases with the radial forearm flaps. METHODS: Seventeen patients undergoing free flap reconstruction between December 1998 and September 2001 have been selected for this retrospective study and evaluated. In fourteeen patients reconstruction was performed with a radial forearm flap. In three patients an anterolateral thigh flap was used. Six dissections on cadavers have also been performed in order to study the anatomical variations of the perforators of the lateral circumflex femoral system. RESULTS: All flaps survived, without any major vascular impairment. CONCLUSIONS: Despite a laborious dissection of the pedicle the anterolateral thigh is a versatile flap, with a minimal morbidity of the donor area. Even if the radial forearm is overall accepted as the gold standard for head and neck reconstruction, the anterolateral thigh flap is suggested as a good and safe surgical option, especially when a large flap is requested or in female patients concerned with the cosmetic result in the forearm donor area.
Aged↗
Breast reconstruction with abdominal flaps after abdominoplasties.
After the reported safe transverse rectus abdominis myocutaneous (TRAM) flap after liposuction of the abdomen, two cases of bipedicled reconstruction with this flap after abdominoplasty were successfully performed. This operation has not previously been considered possible because of the transection of the perforator arteries during the undermining of the abdomen. To examine the possible reperfusion of the perforator arteries, the authors studied the perforator arteries of 10 patients before they underwent abdominoplasty and at 1 week, 3 months, and 6 months after the operation. The arteries were studied with color-duplex scanning and power Doppler, using 10-MHz superficial probes, and their position was marked on a map. A cadaver study of a woman who had had an abdominoplasty 10 years before her death is also presented. In every patient, reperfusion of all perforator arteries was documented, starting from the control at 1 month. In no case was the caliber of the reperfused vessels more than 40 percent of the original diameter (maximum: 0.53 mm). This was also confirmed by the cadaver study. In conclusion, after an abdominoplasty operation, constant reperfusion of the perforator arteries of the rectus muscles occurs. However, the diameter of the arteries may not be enough to provide the necessary blood supply for a TRAM flap, which is therefore strongly discouraged by the authors after abdominoplasty in favor of a vertical rectus abdominis muscle (VRAM) flap. A liposuction, which does not necessarily disrupt the perforators, is not an absolute contraindication for a TRAM flap, provided that an accurate color-duplex scanning study is done.
Abdominal Muscles↗
Current role of immunoscintigraphy in malignant melanoma follow-up. A study of 114 patients.
Although its role and importance is debated, Immunoscintigraphy (IS) remains a popular technique in Malignant Melanoma (MM) follow-up for postoperative assessment. Between April 1990 and December 1996, 287 consecutive patients underwent 650 IS examinations at our Department. Only data on 114 patients, operated up to December 1993, with a follow-up of at least 7 years are given here. IS results were compared to physical examination, to other imaging modalities and, where available, to histology. IS specificity and sensivity, concerning detection of melanoma metastases in lymph nodes, skin, brain, lung, visceral sites and bone, ranged from 37.5% and 22% to 100%. Our results indicate a high diagnostic accuracy of IS only for lymph node examination, but not for other possible locations of melanoma metastases. In our experience IS cannot be recommended for staging of melanoma patients, and should only be used in association with other imaging modalities.
Abdominal Neoplasms↗
Neophalloplasty in female-to-male transsexuals with the island tensor fasciae latae flap.
In the past 60 years, several different procedures have attempted to achieve a postoperative neophallus that is as aesthetic and as functional as possible after penile amputation or sex reassignment. Recently, with improvements in free tissue transfer and microvascular technique, many free flap procedures have been developed with the goal of an aesthetically acceptable neophallus of adequate bulk that enables urination in a standing position and sexual intercourse, with minimal functional and aesthetic donor-site defects. Most authors currently agree that the method of choice for penile reconstruction is microsurgical free tissue transfer, although it does not always fulfill all of the aforementioned goals in a predictable manner. In fact, complete urethroplasty, penile rigidity, and donor-site disfigurement remain challenges, thus making this operation one of the most difficult in plastic surgery. The vascular anatomy of the lateral circumflex femoral artery, which we studied in 1991 with the anatomic dissection of 27 cadavers, gave us the idea to use a long tensor fasciae latae neurovascular island flap as a donor source for neophalloplasty. Grounds for the procedure and its surgical planning have been carefully evaluated with 10 additional fresh cadaver dissections. Since 1991, we have performed five neophalloplasties using this procedure; all patients were female-to-male transsexuals. In four cases, the healing was uneventful; in one case, there was a marginal necrosis of the flap because of poor venous drainage, probably from a twisting of the pedicle. The island tensor fasciae latae provides a safe and sensate flap for phalloplastic procedure and leaves a less conspicuous donor scar.
Adult↗
Effects of traditional and ultrasonic liposuction on adipose tissue: a biochemical approach.
Little is known about the interaction of ultrasonic liposculpture with fat tissue. The surgical technique is well established and its clinical effects are satisfactory. However, the in vivo effects on adipose tissue remain to be determined. Previous studies have shown that ultrasound waves break fat cells. The purpose of this study was to ascertain whether ultrasound waves can cause the release of fatty acids from the molecular structure of triglycerides. A double-blind study was designed with samples obtained from traditional and ultrasonic liposuction of an equivalent area in the same patient. Samples were checked for triglycerides and for free fatty acids. Triglyceride values were always higher in the sample that had undergone ultrasonic procedure. No significant differences were observed between the free fatty acid chromatograms of the two kinds of samples analyzed. Data showed that no changes occurred in the triglyceride molecule when using ultrasound waves in the experimental conditions.
Adipose Tissue↗
[Nonprogressive, late-onset atrophy of the cheek].
Lipodystrophies are rare conditions in which the most remarkable feature is an atrophy of the subcutaneous tissues. Until two decades ago, they were all considered under the name of "lipoatrophic diabetes", and only recently they have been properly classified. Currently four syndromes are recognized: congenital total lipodystrophy, late onset or acquired lipodystrophy, cephalothoracic or partial progressive lipodystrophy and partial face-sparing lipodystrophy. We report the case of a 73-year-old patient, long distance bus driver, who presented to our clinic for the correction of a malar atrophy located on the left side of his face. Until he was 48 years old his appearance was normal, but at the time he reports the slow onset of a facial atrophy which was confined to the cheek. The atrophy was very slowly progressing, so that at this moment at 73 years of age he presented to our observation for the correction of the asymmetry. Clinical examination and history oriented us towards a variation of Parry-Romberg's syndrome characterized by a non progressive late onset hemifacial atrophy. No muscle or bony involvement is present. No other important abnormalities, excluding a moderate hyperglycemia have been observed. A biopsy of the region shows a marked elastosis and a complete atrophy of the subcutaneous fat. Correction of the deformity was achieved with autologous fat injection and was still satisfactory after one year.
Adipose Tissue↗
Clinical use of a new axial chondro-mucosal flap in wide full-thickness eyelid reconstructions.
BACKGROUND AND OBJECTIVE: Full thickness reconstruction of more than half of an eyelid, mainly of the upper one, is a challenge for the surgeon. In 1992, for the first time, the authors reported the use of an axial chondro-mucosal flap from the nose for reconstruction of the tarsoconjunctival plane of a full thickness defect of an eyelid. This article reports and discusses the results of the follow-up of 18 patients operated on using the above technique during the period June 1991-March 1997. PATIENTS AND METHODS: Apart from the oncological evaluation, the following parameters were assessed: position, closure, the presence of epiphora, length of the palpebral rim, rim opening, levator function, an aesthetic balance of the eyelids, and donor site morbidity. The follow-up ranged from 6 to 40 months. RESULTS: The axial chondro-mucosal flap was clinically viable in all patients. One patient showed a 2 mm lagophthalmos. Static parameters were within normal ranges. In upper eyelid reconstruction, an 8 to 18 mm. levator function (mean 13 mm) was shown. CONCLUSION: The authors discuss their complications and results and feel that this flap, associated with full thickness skin grafts, may be considered a first choice technique, in expert hands, in complex full thickness upper eyelid reconstruction, and a possible alternative in lower eyelid reconstruction, for wide defects when the use of other flaps is compromised.
Adult↗
Controversial issues in diagnosis of liposarcomas of the thigh. A report of 18 cases.
Liposarcoma is a common soft tissue neoplasm mainly found in the thigh. Early diagnosis and appropriate treatment are essential for survival, but clinical diagnosis may not be easy, and the importance of imaging is controversial as it often fails to indicate the presence of liposarcoma so that treatment is delayed. We report our experience of 18 cases of liposarcoma (16 of which in the thigh). This experience has led us to revise our opinions about imaging, clinical, and histopathological diagnosis, and the surgical and medical treatment. We now suggest that any hard, subfascial mass in an adult should be considered as a soft tissue neoplasm. Of these neoplasms, liposarcoma is the most common type, after malignant fibrous histiocytoma. Diagnosis by imaging techniques is rarely possible, so that integration with clinical data is essential. Among the various imaging techniques, computed tomography and ultrasound seem to be most useful.
Adult↗