Giant condylomata (Buschke-Löwenstein tumours): our case load in surgical treatment and review of the current therapies.

BACKGROUND: Buschke-Löwenstein tumour (BLT) or giant condyloma is a verrucous infiltrating lesion, due to a sexually transmitted virus infection, human papilloma virus subtypes 6 and 11. Poor hygiene, promiscuity, chronic irritation and cellular immunocompromised states are often implicated in its genesis. Typical treatment of giant condyloma includes imiquimod cream, podophillin resin, cryotherapy, laser surgery, tangential shave excision with electrocautery. OBJECTIVE: The authors report their case load in the treatment of giant condyloma and the review of the modern therapies. METHODS AND MATERIALS: 27 consecutive patients (18 men, nine women) underwent surgery for giant condylomata of perianal region and externa genitalia at the Department of Plastic Surgery of the University of Palermo, from October 2006 to December 2009. All the patients had been treated before with conservative therapies without significant results. We performed the radical excision with split-thickness skin graft in all the patients. RESULTS: No significant complications have occurred in all the cases. The functional and aesthetic outcome were satisfying. No recurrence of disease were noticed in the follow-up. CONCLUSION: the radical excision with split-thickness skin graft appears to be a successful option of treatment for Buschke-Löwenstein tumours. Compared to other methods it does not necessitate several stages of treatment, moreover it has the advantage of a lower risk of recurrence, it allows a complete histologic examination, the healing process is rapid, the improvement of quality of patients's life is significant

A propeller flap for single-stage nose reconstruction in selected patients: supratrochlear artery axial propeller flap

The paramedian forehead flap is the gold standard technique for nose reconstruction. It requires two different surgical operations which prolonged the postoperative dressing and care. We present our 5-year experience with a propeller flap based on the supratrochlear artery, which allows one-stage transfer of the forehead skin to the nose without the need for pedicle division. This technique is indicated in a selected group of patients who are not suitable for multiple-stage reconstructions because they have concurrent medical conditions, reduced mobility, or live far away from specialized medical centers. We have renamed this procedure as supratrochlear artery axial propeller flap, from the acronym STAAP flap, to stress the axial, well known and constant, vascularization of the flap. In the past 5 years, we have been performing 25 STAAP flaps; full-thickness nasal reconstruction was performed in 11 cases. The patients were 16 males and 9 females, with a mean age of 79.5 years. All patients had multiple comorbidities. Complete flap survival was observed in 23 cases and healing was complete in 7 days. In two cases, there was a partial distal necrosis of the flap treated conservatively. Cosmetic results were good and the patient's satisfaction was significant. These results indicate that the STAAP flap is a reliable and useful technique in selected cases, as old or noncompliant patients who benefit from a one-stage technique of nose reconstructio

Adipose-derived stem cells: true or false? A different point of view

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A difficult case of necrotizing fasciitis caused by Acinetobacter baumannii

This study reports the case of a 55-year-old woman with diabetes with a necrotizing fasciitis of the right lower limb and the perineum, first admitted at the emergency department for septic shock with cardiac arrest, and later transferred to the department of surgery. Microbiological and histopathological examination confirmed the diagnosis of necrotizing fasciitis caused by Acinetobacter baumannii. A broad-spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture. Intensive hemodynamic support was required. Wounds were dressed daily with a 3 percent boric acid solution and a silver sulfadiazine-impregnated dressing. An extensive surgical debridement was promptly performed and repeated until complete control of the infection. Wounds were finally covered with split-thickness skin grafts. The infection was overcome 35 days after admission. The graft take was 100%. Postoperative rehabilitation was required because of the functional limitation of lower limb movements. Follow-up at 6 months showed no functional deficit and an acceptable aesthetic result. Necrotizing fasciitis is a life-threatening disorder, especially in patients with diabetes, whose clinical diagnosis may sometimes be challenging. Early recognition and treatment represent the most important factors influencing surviva

Massless scalar field in two-dimensional de Sitter universe

We study the massless minimally coupled scalar field on a two--dimensional de Sitter space-time in the setting of axiomatic quantum field theory. We construct the invariant Wightman distribution obtained as the renormalized zero--mass limit of the massive one. Insisting on gauge invariance of the model we construct a vacuum state and a Hilbert space of physical states which are invariant under the action of the whole de Sitter group. We also present the integral expression of the conserved charge which generates the gauge invariance and propose a definition of dual field.Comment: 13 page

Skewed Differentiation of Circulating Vγ9Vδ2 T Lymphocytes in Melanoma and Impact on Clinical Outcome

Objective The aim of this study was to evaluate over time circulating γδ T lymphocytes in melanoma patients in terms of frequency, effector functions, and relationship with clinical stage and evolution, by comparing preoperative values to those obtained at a mean follow-up of 36 months or in the event of recurrence or disease progression, and to those of healthy controls. Also, we correlated the presence of tumor-infiltrating γδ T lymphocytes with clinical evolution of melanoma. Results Mean frequencies of circulating γδ T cells before and after melanoma removal were very similar and comparable to healthy subjects, but patients who progressed to stage III or IV showed a significantly decreased frequency of circulating Vγ9Vδ2 T cells. The distribution of Vγ9Vδ2 memory and effector subsets was similar in healthy subjects and melanoma patients at diagnosis, but circulating γδ T cells of patients after melanoma removal had a skewed terminally-differentiated effector memory phenotype. Highly suggestive of progressive differentiation toward a cytotoxic phenotype, Vγ9Vδ2T cells from patients at follow up had increased cytotoxic potential and limited cytokine production capability, while the opposite pattern was detected in Vγ9Vδ2T cells from patients before melanoma removal. Conclusions Follow-up data also showed that tumor infiltrating γδ T cells were significantly associated with lower mortality and relapse rates, suggesting that they may serve as a prognostic biomarker, for human melanom

Persistent high-growth firms in China’s manufacturing

This article explores the association between persistence of high-growth and crucial dimensions of firm structure and performance (productivity, profits, investment patterns, innovation, and financial structures) to shed light on what makes a persistent high-growth firm. We employ a multidimensional definition of a high-growth firm that simultaneously accounts for growth of sales and employment, and design an empirical strategy that seeks to capture the “long-run” ability of high-growth firms to replicate their high-growth performance over time. Exploiting a large panel covering the period of the China’s miracle, we find that none of the considered firm attributes stands out as distinctive feature of persistent high-growth. This finding casts doubts on the long-run contribution of high-growth firms, in turn challenging the long-run effectiveness of policies supporting the creation and expansion of such firms

Conservation laws and scattering for de Sitter classical particles

Starting from an intrinsic geometric characterization of de Sitter timelike and lightlike geodesics we give a new description of the conserved quantities associated with classical free particles on the de Sitter manifold. These quantities allow for a natural discussion of classical pointlike scattering and decay processes. We also provide an intrinsic definition of energy of a classical de Sitter particle and discuss its different expressions in various local coordinate systems and their relations with earlier definitions found in the literature.Comment: 25 pages, 1 figur

Solitary Fibrous Tumor of the Lower Leg: A Rare and Difficult Diagnosis

Solitary fibrous tumor (SFT) is a rare neoplasm that commonly originates in the pleura. Extrapleural locations are rare and for this reason sometimes difficult to diagnose. Malignant forms with local recurrence or distant metastases have been reported, also as a consequence of inappropriate treatment. In this article, we report the case of an SFT of the lower leg in a 37-year-old man. Leg SFT is a rare occurrence, and differential diagnosis may be difficult because they can mimic a variety of benign and malignant mesenchymal tumors; immunohistochemical analysis for CD34, CD99, vimentin, and Bcl-2 is necessary. Misdiagnosis carries a significant risk of inadequate removal with subsequent increased risk of recurrence and distant metastases

More about the Tolman-Oppenheimer-Volkoff equations for the generalized Chaplygin gas

We investigate the Tolman-Oppenheimer-Volkoff equations for the generalized Chaplygin gas with the aim of extending the findings of V. Gorini, U. Moschella, A. Y. Kamenshchik, V. Pasquier, and A. A. Starobinsky [Phys. Rev. D {\bf 78}, 064064 (2008)]. We study both the standard case, where we reproduce some previous results, and the phantom case. In the phantom case we show that even a superluminal group velocity arising for $\alpha > 1$ cannot prevent the divergence of the pressure at a finite radial distance. Finally, we investigate how a modification of the generalized Chaplygin gas equation of state, required by causality arguments at densities very close to $\Lambda$, affects the results found so far.Comment: 8 pages, revtex style, minor stylistic changes, typos corrected. It matches the published versio