Malignant Scalp Tumors: Retrospective Analysis of 1000 Patients.

Abstract Background: Limited data on large cohort of patients with malignant tumors of the scalp are available in the literature. e aim of this study was to review a large cohort of patients with malignant scalp tumors to determine epidemilogy, tumor characteristics of this region and treatment. Materials and Method: A retrospective review of patients with malignant scalp tumors diagnosed histopathologically between 2005 and 2021 was performed. Demographic features and tumor characteristics were analyzed. Results: A total of 1080 patients (M: F 3,5:1) were treated and followed up for a mean period of 42 months (12-120 months). Age at diagnosis ranged from 12 to 98 years. Most malignant scalp tumors (95,1%) occurred in those 50 years or older and in bald patients (87%). Basal cell carcinomas (59,2%), squamous cell carcinomas (32,2%) and melanomas were the most common histologic types. Incidence was highest on the frontal of temporal region (66,1%). Recurrence was frequently in squamous and basal cell carcinomas but uncommon in melanoma. Conclusions: Tumors of the scalp accounted about 8,01 % of all skin cancers. Tend to be basal and squamous cell carci- nomas, many of which occur in the temporal and frontal region of bald men. e outlook for patients with scalp tumor is positive, although we suggest excision margins of at least 3-4 mm and continued clinical vigilance is warranted given their higher recurrence rates. MLN: Melanom

Aziende familiari, ricambio generazionale e assetti di governance

Nel primo capitolo viene analizzato il sistema economico italiano con le sue peculiarità ed i propri limiti. In particolar modo viene posta l'attenzione sulle aziende familiari e sulla loro possibile classificazione, esaminandone il processo evolutivo ed il rapporto che si instaura tra la famiglia e l'impresa. Nel secondo capitolo viene posta l'attenzione sul ricambio generazionale come strumento fondamentale per la continuità dell'impresa familiare, definendone la pianificazione, le caratteristiche e le varie problematiche riguardanti il processo successorio con le relative possibili soluzioni. Infine, nel terzo capitolo viene approfondito il tema della corporate governance, concentrandosi quindi sui metodi di governo dei family business e sul ruolo che il consiglio di amministrazione svolge in questo tipo di imprese, anche nell'ottica del passaggio generazionale. L'analisi si sposta inoltre sugli ulteriori organi di governo dell'impresa e della famiglia, sul modello di leadership collegiale e sul ruolo dei patti familiari

Transdermal Nitroglycerine Patch: An Optional Device to Reduce Flap Venous Congestion? A Case Report

ABSTRACT Sometimes in free flap there is a venous congestion without an obstruction of the venous anastomosis or other organic causes of reduction venous drainage (haematoma, seroma compressing the pedicle). In these cases the authors suggest the application of nitroglycerine patch in the congested area of the flap few hours before the surgical exploration of the anastomosis. If there is a fast improvement of the clinical feature of the flap, the surgical exploration could be avoided. The authors underline that applying the nitroglycerin patch should not be regarded in any way as a therapy of a free flap venous thrombosis but only as an useful device, an option to be taken only when the surgeon is undecided whether to revisit the anastomosis or not

Surgical Prevention of Arm Lymphedema in Breast Cancer Treatment

Disruption of the axillary nodes and closure of arm lymphatics can explain the significantly high risk of early and late lymphatic complications after axillary dissection, especially the most serious complication that is arm lymphedema which occurs in about 25% (ranging from 13 to 52%) of patients. Sentinel lymph node (SLN) biopsy has reduced the severity of swelling to nearly 6% (from 2 to 7%) and, in case of positive SLN, complete axillary dissection (AD) is still required. That is why ARM method was developed aiming at identifying and preserve lymphatics draining the arm. It consists in injecting intradermally and subcutaneously a small quantity (1-2 ml) of blue dye at the medial surface of the arm which helps in locating the draining arm lymphatic pathways. ARM technique allowed to find variable clinical anatomical conditions from what was already generally known, that is the most common location of arm lymphatics below and around the axillary vein. In about one-third of the cases, blue lymphatics can be found till 3-4 cm below the vein, site where SLN can easily be located, justifying the occurrence of lymphedema after only SLN biopsy. ARM procedure showed that blue nodes were almost always placed at the lateral part of the axilla, under the vein and above the second intercostals brachial nerve. Leaving in place lymph nodes related to arm lymphatic drainage would decrease the risk of arm lymphedema, but not retrieving all nodes, the main risk is to leave metastatic disease in the axilla. Conversely, arm lymphatic pathways when they enter the axilla, cannot be site of breast tumoral disease and their preservation would certainly bring about a significant decrease of lymphedema occurrence rate

Histology of the Oral Mucosa in Patients With BRONJ at III Stage: A Microscopic Study Proves the Unsuitability of Local Mucosal Flaps.

BACKGROUND: Bisphosphonate Osteonecrosis of the Jaw (BRONJ) is a newly recognized condition reported in patients treated with aminobisphosphonates (BF). BRONJ is defined as the presence of exposed necrotic alveolar bone that does not resolve over a period of 8 weeks in a patient taking bisphosphonates who has not had radiotherapy to the jaw. Treatment protocols have been outlined, but trials and outcomes of treatment and long-term follow-up data are not yet available. In 2004 an expert panel outlined recommendations for the management of bisphosphonate-associated osteonecrosis of the jaws. Through the histological study of the oral mucosa over the bone necrosis and around the osteonecrosis area in 8 patients affected by BRONJ at III stage, the authors highlight the inappropriateness of the local mucosal flaps to cover the losses of substance of the jaw, BF-related. METHODS: Mucosa tissue was taken from 8 patients, affected by BRONJ, III stage. The samples taken from the mucosa around and over the osteonecrosis area were fixed with formalin and an ematossilina-eosin dichromatic coloring was carried out. RESULTS: The samples of mucosa showed pathognomonic signs of cell suffering that prove that in these patients using local mucosa flaps is inappropriate. CONCLUSIONS: The authors suggest that only a well vascularized flap as free flap must be used to cover the osteonecrosis area in patients with BRONJ stage III. Because of the structural instability of the mucosa in patients suffering of osteonecrosis Bf related the local flaps are prone to ulceration and to relapse

VOLCANICLASTIC DEPOSITION AND MIGRATION OF BASIN DEPOCENTRES AFTER THE ERUPTION OF THE NEAPOLITAN YELLOW TUFF: THE POZZUOLY BAY (NAPLES, ITALY)

The Campi Flegrei is an active caldera located on the coastal zone of SW Italy (Fig. 1), close to the town of Naples Bay, that has been characterized by explosive activity and unrest throughout the Late Quaternary. This area represents a very active segment of the Eastern Tyrrhenian margin and may be regarded as an ideal laboratory to understand the mechanisms of caldera dynamics and the interplay between volcanism, tectonics and sedimentary processes along a continental back-arc margin. Recent research at Campi Flegrei has shown that a significant part of the offshore volcaniclastic products and structures, the late-stage geodynamic evolution of the inner caldera resurgence and the stratal geometry of the caldera fill are still poorly known. Particularly, highresolution seismic data highlight the presence of an intra-caldera resurgent dome in the inner sector of the Pozzuoli bay that underwent significant uplift/subsidence after the eruption of the NYT (Sacchi et al., this volume). In this study we integrate geophysical data of different resolution/penetration obtained from high-resolution reflection seismic profiles (Chirp and Sparker sources) partly calibrated by gravity core in order to provide a 3D depositional model of density flows and migration of basin depocentres for the Pozzuoli Bay after the eruption of the NYT. The new data document the occurrence of two distinct layers of resediments, mostly represented by density flow deposits, separated by an interval of hemipelagic sediments. The two density flow units display a remarkable difference in their thickness and internal geometry. Across the bay, the lower unit is ca 5m thick in the western sector and reaches its maximum of ca 10 m in the central sector while it is absent towards the east. The upper unit, on the contrary, displays the minimum thickness of 10m close to the central sector of the bay and increases up to ca 16 and 12m in the western and eastern sector of the bay, respectively. The variation in thickness of the density flow deposits appears to be related with the amount of sediments available. The upper density flow deposits is also internally more chaotic respect to the lower one, suggesting higher energy and/or turbulence (Fig. 2). Sections and isopach maps clearly illustrate that the basin depocentre topography is not fixed at one position but migrates southwards in time (Fig. 3). Based on the above observations, we suggest that the uplift of the resurgent dome and subsidence of the southern sector, occurred after the eruption of the Neapolitan Yellow Tuff, acted as a major control in the increase of the sea-floor gradient in the Pozzuoli bay. This may have triggered in turn, the deposition of gravity flow deposits along with a progressive migration of basin depocentres through time

Architettura stratigrafica ed evoluzione del Golfo di Pozzuoli negli ultimi 15 ka:una nuova prospettiva sulla caldera del Tufo Giallo Napoletano,Campi Flegrei, margine tirrenico orientale.

I Campi Flegrei rappresentano un distretto vulcanico attivo che si sviluppa al confine tra il settore emerso e sommerso del margine continentale campano. Il distretto vulcanico occupa una superficie di circa 200 km2, è strutturalmente dominato da una caldera di collasso del diametro di circa 8 km formatasi in seguito all’eruzione del Tufo Giallo Napoletano (TGN), un deposito ignimbritico del volume di 30-50 km3 Dense Rock Equivalent, datato a 15 ka B.P. circa, ed è attivo da almeno 78 ka B.P circa. L’obiettivo di questo lavoro è di ricostruire l’architettura stratigrafica e l’evoluzione vulcanotettonica tardo-Quaternaria del sistema caldera di collasso - faglia anulare - risorgenza intra-calderica del settore sommerso della caldera del TGN. A tal fine è stata analizzata una fitta maglia di profili sismici a riflessione monocanale di alta (Sparker) ed altissima (Subbottom Chirp) risoluzione. I dati sismici sono stati successivamente integrati sia con quelli ottenuti dall’analisi di carotaggi a gravità e batimetrici multibeam che con quelli disponibili in letteratura e, nell’insieme, analizzati in ambiente GIS. I nuovi dati indicano che il settore interno dell’area collassata a seguito dell’eruzione del TGN evolve inizialmente in condizioni di mare basso. L’area intra-calderica viene successivamente interessata dalla formazione di una struttura antiforme (risorgenza intra-calderica) il cui tasso di sollevamento è stato comparabile con l’innalzamento eustatico nell’intervallo Pleistocene superiore – Olocene [Lambeck et al., 2011]. A circa 10 ka B.P. il settore centrale della struttura risorgente raggiunge l’esposizione subaerea (terrazzo morfologico de “La Starza”). La calibrazione dei profili sismici Chirp con markers tefro-stratigrafici riconosciuti in un carotaggio e datati al 1538 A.D., 79 A.D. indica l’instaurarsi di un periodo di subsidenza in epoca post-Romana, registrato dall’annegamento di 10-25 m del cuneo di progradazione infralittorale rispetto alle profondità di equilibrio funzionale attualmente segnalate in area Mediterranea. L’interpretazione sismostratigrafica rivela, inoltre, la presenza di fluidi che risalgono attraverso la zona di faglia anulare che delimita la caldera del TGN. Bibliografia Lambeck, K., Antonioli, F., Anzidei, M., Ferranti, L., Leoni, G., Scicchitano, G., Silenzi, S., (2011). Sea level change along the Italian coast during the holocene and projections for the future. Quaternary International, 232, 250-257