Bilateral reconstruction of the mandibular body with symphyseal preservation using a single fibula free flap: operative technique

Background: Mandibular osteonecrosis may occur in 5% of the patients who undergo radiotherapy for the treatment of head and neck malignancies. Resection and microvascular reconstruction is the treatment of choice in complicated osteoradionecrosis, however multifocal presentation may complicate the management of the disease given the poor quality and limited availability of adequate recipient vessels. Operative technique: A 74-year-old man affected by multifocal severe osteoradionecrosis of the mandible underwent bilateral resection of the mandibular bodies while preserving the symphysis. The defects were reconstructed with a single fibula flap composed by two bony segments connected by a central segment, corresponding to the symphyseal region, in which the bone was dissected and removed. The anastomosis was performed on a single side of the neck. Healing was uneventful and the adopted technique allowed for a quick functional and esthetic recovery. Conclusion: The presented technique provided a safe and efficacious, although technically challenging, solution in a case presenting multifocal osteonecrosis of the jaw. The morbidity of the procedure was limited because the tissue resection and reconstruction processes were minimized. Graphical Abstract: [Figure not available: see fulltext.

Survey and modelling for the bim of Basilica of San Marco in Venice

The Basilica of San Marco is a singular case in the field of Cultural heritage, as it constitutes a construction site always active for the maintenance and preservation of the basilica itself. The continuous intervention of conservation, due to the particular environmental conditions of Venice and the opening to the public, together with the complexity of the building itself, imposes the need to identify an optimized management system. For this reason, in 2013 the Procurator of St. Marco Basilica commissioned the construction of a 3D model of the Basilica to be used for the creation of a BIM. The model must meet the required precision of the scale of 1: 50, and should also include, in addition to the geometric description, a description of the mosaic and marble surfaces of the basilica through high resolution orthophoto which are essential for the restoration of the mosaics. The complexity of the church and the large and continuous flow of public led to work in non-optimal conditions especially for the acquisition stage. The basilica has certain peculiarities that led to some important choices, for example the use of photogrammetry instead of laser scanning technique. The same technique was preferred also by the need to realize, in addition to the geometric model, high-resolution orthophotos of marbles and mosaic surfaces. The modelling of the basilica has highlighted a number of problems related to the building features. The basilica, indeed, is the result of the juxtaposition of elements (capitals, columns) with different origin, which therefore cannot be standardized in special libraries. Moreover, especially in the extensive mosaic areas, there are not edges that characterize the architecture, but only beveled surfaces. This has resulted in a change also in the modeling paradigm with the need to identify alternative systems even for the construction of simple elements. Therefore, we decided to model using NURBS since it is the method that allows greater adherence to reality and, at the same time, a model with acceptable dimensions in terms of navigation and usability. Only the most sculptural pieces such as capitals and statues have been replaced by mesh models. As we were interested in different elaborations, the results of this work are a geometric NURBS model for the subsequent insertion into BIM environment, with the possibility of extracting two-dimensional drawings such as plans and sections, a mesh model with low resolution textures for online navigation and high resolution orthophotos. The survey work and modeling has been almost completed for the interior of the basilica whereas only the external remains to be acquired and modeled. For the management of the entire work it was decided to use the data organization system already used by the Politecnico di Milano for the Duomo di Milano. The BIM3DSURVEY system will be essential not only to manage the finished model, but it has been very useful also during the construction phase because it allows us to divide the entire work into more work units. However, this system required some changes to meet the peculiarity of this BIM, in particular the need to append and link the orthophotos to real surfaces, in order to use the model also as a spatial index for the images

Folded Radial Forearm Free Flap for the Reconstruction of Total Soft Palate Defects: Operative Technique

Background: The surgical plan to reconstruct the palate must be carefully prepared given the morphological peculiarity of the soft palate forming both the roof of the mouth and the floor of the nasal cavity. This article focuses on the use of folded radial forearm free flaps to manage isolated defects of the soft palate in the absence of tonsillar pillar involvement. Methods: Three patients affected by squamous cell carcinoma of the palate underwent resection of the soft palate and immediate reconstruction with a folded radial forearm free flap. Results: All three patients showed good short-term morphological-functional outcomes as far as swallowing, breathing, and phonation were concerned. Conclusions: The folded radial forearm free flap seems to be an efficacious way to manage localized defects of the soft palate, given the positive outcomes of the three patients treated, and in accordance with other authors. In general, the radial forearm free flap was confirmed to be a versatile solution for those intraoral defects of the soft tissue requiring a limited quantity of volume as in the case of the soft palate

Reduced T-cell repertoire restrictions in abatacept-treated rheumatoid arthritis patients.

BACKGROUND: CD28(neg) T cells, which display functional characteristic of oligoclonally expanded cytotoxic memory T lymphocytes, are believed to be pathologically relevant in rheumatoid arthritis manifestation. The CD28 co-stimulation blockade by abatacept can prevent the generation of CD28(neg) T-cell populations in these patients. METHODS: Samples were obtained before and after 12 months of abatacept therapy. T-cell phenotype and T-cell receptor diversity were evaluated by flow cytometry and complementarity-determining region-3 spectratyping, respectively, while telomerase reverse-transcriptase gene level was measured by real-time PCR. RESULTS: Abatacept induces a decrease of the percentage and number of CD4(+)CD28(neg) T cells and a reduction of T-cell repertoire restrictions; these features are directly correlated. Thymic output and telomerase activity are not modified by the therapy. CONCLUSIONS: Abatacept-induced decrease of peripheral T-cell repertoire restrictions can due to a reduced generation of senescent, chronically stimulated CD4(+)CD28(neg) T cells

Clinical Management of Acinic Cell Carcinoma of the Lacrimal Gland

To report a case of acinic cell carcinoma occurred in the lacrimal gland. A 59-year-old man was admitted because of sudden blurring of vision, progressive proptosis of the left eye, and mild double vision in left and down directions of the gaze (Hess-Lancaster test). His medical history detailed controlled bilateral keratoconus and open angle glaucoma. On examination, the best corrected visual acuity decreased from 8/20 till 1/50 in one week. There was a swelling of the left upper eyelid. A hard and tender mass was palpated in the superior temporal left orbit. Ultrasound scan showed an extraconal solid mass, situated in the superior lateral corner of the orbit. Computed tomography and magnetic resonance imaging (MRI) revealed a mass of two centimeters in diameter, with round well-defined outline, within the lacrimal gland. We per-formed an enucleoresection of the mass, via a coronal approach and a lateral orbitotomy by a piezosurgical device. The lesion appeared nodular, brownish, measuring about 2 7 1.5 cm. Histopathological findings were consistent with acinic cell carcinoma with a microcystic, focally papillary-cystic growth of pattern. Follow-up MRI outcomes led to removal of the residual lacrimal gland for suspicion of recurrence. No tumor recurrences where detected at 7-year follow-up

The 4 K outer cryostat for the CUORE experiment: construction and quality control

The external shell of the CUORE cryostat is a large cryogen-free system designed to host the dilution refrigerator and the bolometers of the CUORE experiment in a low radioactivity environment. The three vessels that form the outer shell were produced and delivered to the Gran Sasso underground Laboratories in July 2012. In this paper, we describe the production techniques and the validation tests done at the production site in 2012.Comment: 11 pages, 13 figures; to appear in NIM

Aneurysmal bone cyst of the nasal bone: case report

The aneurysmal bone cyst (ABC) is a solitary, expansile, non-neoplastic bone lesion, described as a distinct clinicopathological entity by Jaffe and Lichtenstein. We report a case of an ABC arising from the nasal bone in a adult male patient treated with complete surgical excision