L'acqua come risorsa paesaggistico-ambientale

Sumario: I. I diversi profili giuridicamente rilevanti del bene acqua. La sua progressiva rarefazione alla base della presa di coscienza del suo valore.— ii. L’ulteriore profilo dato dalla rilevanza paesaggistica.— iii. Il rapporto ambiente, paesaggio, pianificazioni.— iv. La non inconciliabilità della configurazione del bene culturale come bene ambientale.— v. Il governo del territorio come principale strumento di tutela paesaggistica. L’intreccio con gli altri aspetti di tutela dell’acqua.— vi. La tutela in via preventiva attraverso l’autorizzazione paesaggistica e i rapporti tra questa e il permesso di costruire.— vii. Le incongruenze nella disciplina attuale dell’autorizzazione paesistica in sanatoria.— viii. Considerazioni conclusive

A Misdiagnosed Metastatic Squamous Cell Carcinoma of the Vulva

BACKGROUND: Early diagnosis of vulvar squamous cell carcinoma (SCC) is directly related to better prognosis and higher survival rate. Missed gynecologist follow-up, some cultural traditions and refrain from facing with a problem that involves intimacy and sexual sphere can be the cause of delayed diagnosis and treatment. Radical surgery still represents the gold standard, but narrow excision margins can progressively lead to local recurrence, even after years. CASE REPORT: The case we present is a rare case of misdiagnosed metastatic SCC of the vulva after radical excision and groin dissection 2 years before. After a full-through discussion with patient on treatment options and prognosis, a multidisciplinary surgical approach was planned, consisting in wide surgical resection of groin, part of mons pubis and right pelvic iliac-obturator lymphadenectomy. Femoral artery excision was performed due to absence of a clear margin, and reconstruction was accomplished with interposed great saphenous vein graft. The plastic reconstruction consisted in harvest of transverse rectus abdominal flap (TRAM), that was transposed inferiorly to repair right groin. Pathologist confirmed free margins of excision and pelvic lymph nodes resulted negative (pT1b, N3, M0 – stage IV A). DISCUSSION: When deep structures of the groin - such as femoral vessels - are involved by relapse, the condition is potentially life-threatening. A multidisciplinary approach consents to perform a radical surgery with free margins and likewise to achieve a satisfying functional reconstruction. CONCLUSION: This case should emphasize that skin ulceration on a non-weight-bearing surface is always suspicious for skin malignancy, an incisional biopsy is easy to perform and consents a rapid diagnosis. A history of recurrent vulvar SCC should always warn about the risk of late lymph node metastasis even years after a radical excision of the primary tumor and concomitant lymphadenectomy

Management and Clinical Aspects of Burned Patients Affected by SARS-COV2

At the end of January 2020, SARS-CoV-2 started escalating worldwide. COVID-19 can exert its effects on immunity, inflammation, and multi-organ system disease, common denominators with the burn injury. The pandemic required major efforts to Burn centres in order to preserve burn patients’ care and contribute to the health care response. In our Burn Unit we autonomously developed a protocol for patients acceptance and surveillance of the hospitalized ones and the personnel. We briefly describe our experience with six cases of burn patients infected by SARS-CoV-2 highlighting the overlap between medical treatment of burn patients and COVID-19 patients. To avoid viral spreading epidemiologic control is essential, especially preventive measures such as isolation of infected patients and identification of the source of infection. In our surgical practice, we increased the use of enzymatic debridement avoiding procedures with a high risk of viral particles spreading. Personnel protection and dedicated pathways have been planned, optimizing air circulation and disinfection. Vaccines represent the best hope for the global population to stop the viral spread, despite new variants outbreaks

L’acqua come risorsa paesaggistico-ambientale

Sumario: I. I diversi profili giuridicamente rilevanti del bene acqua. La sua progressiva rarefazione alla base della presa di coscienza del suo valore.— ii. L’ulteriore profilo dato dalla rilevanza paesaggistica.— iii. Il rapporto ambiente, paesaggio, pianificazioni.— iv. La non inconciliabilità della configurazione del bene culturale come bene ambientale.— v. Il governo del territorio come principale strumento di tutela paesaggistica. L’intreccio con gli altri aspetti di tutela dell’acqua.— vi. La tutela in via preventiva attraverso l’autorizzazione paesaggistica e i rapporti tra questa e il permesso di costruire.— vii. Le incongruenze nella disciplina attuale dell’autorizzazione paesistica in sanatoria.— viii. Considerazioni conclusive

On the customization of the irradiation patterns of probes for laser tumor ablation with integrated temperature sensing capabilities

The paper reports some results on the customization of the irradiation pattern of an all-fiber applicator for laser induced thermal therapies of solid tumors. The probe exploits a double cladding fiber structure to simultaneously guide the high power beam for the ablation and the signals for the interrogation of embedded Bragg gratings that add temperature sensing capabilities. The probe was characterized using phantoms so as to mimic real situations while providing a repeatable environment for comparing the different solutions in terms of irradiation pattern shapes and induced temperature profiles

Complete Implant Wrapping with Porcine-Derived Acellular Dermal Matrix for the Treatment of Capsular Contracture in Breast Reconstruction: A Case-Control Study

Background Capsular contracture (CC) represents one of the most common complications in breast reconstruction surgery, impairing final result and patients' well-being. The role of acellular dermal matrixes (ADM) has been widely described for the treatment and prevention of contracture. The aim of the study was to evaluate the efficacy and safety of complete implant coverage with porcine-derived ADM in preventing CC limiting complications. In addition, patients' reported outcomes were evaluated in order to define the role of ADM in improving sexual, physical and psychosocial well-being and satisfaction.Methods 42 patients who underwent surgical treatment of 46 contracted reconstructed breasts from May 2018th to May 2019th were collected in the two groups (ADM group vs. Control group).Results The ADM group showed lower rate of CC recurrence and a higher rate of implant losses and minor complications. A significant difference was observed in red breast syndrome (27.3% in the ADM group vs. absent in control the group) and skin ulceration rates (18.2% in the ADM group vs. 4.18% in the control group). As for patients' perceived outcomes, the ADM group showed a statistically significant higher postoperative Satisfaction of Breast Scale score compared to the control group. In addition, a significant difference was observed in the improvement of Physical Well-Being of the Chest Scale and the Satisfaction of Breast Scale after surgery, in favor to the ADM group.Conclusion Complete implant coverage with ADM may reduce the risk of CC recurrence in breast reconstruction. An accurate patient selection allows minimizing complications improving patient well-being and satisfaction