Effective Surgical Management of a Large Serous Ovarian Cyst in a Morbidly Obese Middle-Aged Woman: A Case Study and Literature Review

Background: In contemporary gynecological practice, encountering giant ovarian tumors is a rarity. While most are benign and of the mucinous subtype, the borderline variant only accounts for approximately 10% of these cases. This paper addresses the paucity of information about this specific subtype, emphasizing critical elements of managing borderline tumors that can pose life-threatening complications. Additionally, a review of other documented cases of the borderline variant in the literature is also included to foster a deeper understanding of this uncommon condition. Case Report: We present the multidisciplinary management of a 52-year-old symptomatic woman with a giant serous borderline ovarian tumor. Preoperative assessment showed a multiloculated pelvic-abdominal cyst responsible for compression of the bowel and retroperitoneal organs, and dyspnea. All tumor markers were negative. Together with anesthesiologists and interventional cardiologists, we decided to perform a controlled drainage of the cyst of the tumor, to prevent hemodynamic instability. Subsequent total extrafascial hysterectomy, contralateral salpingo-oophorectomy, and abdominal wall reconstruction, followed by admission to the intensive care unit, were also conducted by the multidisciplinary team. During the postoperative period, the patient experienced a cardiopulmonary arrest and acute renal failure, which were managed by dialysis. After discharge, the patient underwent oncologic followup, and after 2 years, she was found to be completely recovered and disease free. Conclusions: Intraoperative controlled drainage of Giant ovarian tumor fluid, planned by a multidisciplinary management team, constitutes a valid and safe alternative to the popular choice of “en bloc” tumor resection. This approach avoids rapid changes in body circulation, which are responsible for intraoperative and postoperative severe complications

The profunda artery perforators: Anatomical study and radiological findings using computed tomography angiography in patients undergoing PAP flap breast reconstruction

Background: The popularity of the profunda femoris artery perforator (PAP) flap is increasing; however, knowledge concerning the standardization of radiological findings and their clinical implications is limited. We evaluated the radiological architecture of posterior thigh perforators using Computed Tomography Angiography (CTA) to identify landmarks to facilitate flap dissection. Methods: A retrospective study was conducted on 35 patients who underwent unilateral breast reconstruction with a PAP flap. The preoperative CTA scans were analyzed, and the perforator characteristics were evaluated. The perforators were mapped using a Cartesian coordinate system. Data were normalized by anatomical landmarks and overlapped. Perioperative and postoperative results were analyzed. Radiological and intraoperative were compared. Results: Two CTA scans were excluded; 66 thighs were examined. The mean perforator number was 3.2. The mean diameter of chosen perforators was 2.7 mm (DS ± 0.6 mm) at the origin, 2.2 mm (DS ± 0.4 mm) at the adductor space midpoint, and 1.7 mm (DS ± 0.3 mm) at the deep fascia. The mean adipose tissue thickness was 3.35 cm (DS ± 0.94) at the deep fascia and 3.59 cm (DS ± 1.19) at the adductor space midpoint. Intraoperatively, the perforator was located 3.22 cm (DS ± 0.87) from the posterior border of the gracilis muscle and 8.98 cm (DS ± 1.44) from the inferior gluteal crease. A radiological area located 9.33 cm (DS ± 4.81) from the y-axis and 7.48 cm (DS ± 1.88) from the x-axis was identified. Conclusions: CTA using the volume-rendering technique is a valuable method to study in vivo the radiological anatomy of the posterior thigh perforators

Avulsion thighplasty:what about the consent for loss of reconstructive options for microsurgical breast reconstruction?

Avulsion Thighplasty: What about the Consent for Loss of Reconstructive Options for Microsurgical Breast Reconstruction?

Sawmark Analysis of Three Cases of Amputation and a Craniotomy from the Seventeenth and Eighteenth Centuries Hospital Necropolis of Forlì Campus (Forlì, Italy)

The seventeenth-eighteenth century hospital necropolis of Forlì Campus (Forlì, Italy) was discovered during the Forlì Campus building work in 2014. Three cases of limb amputation and a craniotomy are examined using the forensic approach of sawmark analysis in order to understand features of the surgical instruments employed and to gain insight into the position of the surgeon during the cutting actions. With the aid of high definition photographs and moulds, we analyzed the cut surfaces of each sample, also using stereomicroscopy and SEM (Scanning Electron Microscopy). A qualitative and quantitative approach was used in the analysis of the kerf features (e.g. breakaway spur and notch, tooth scratches and hop, exit chipping), and empirical evidence was compared against comparisons coeval surgical essays. We hypothesize that a linear hand-powered push saw and an alternated push saw with a 2mm distance between the teeth were used for amputations. The craniotomy was executed presumably using a linear hand-powered saw with the set of the blade circa 1.3mm wide. Through the application of forensic methods on individuals from archaeological context we describe early cases of surgical practice in a more technical way

Survival in Patients with Primary Parotid Gland Carcinoma after Surgery—Results of a Single-Centre Study

This study aims to analyse a single-centre cohort series of patients who underwent parotidectomy for primary malignant parotid tumours. A retrospective chart review of 64 consecutive patients treated from November 2010 to March 2022 was performed. Outcomes were analysed by Kaplan-Meier curves. Sixty-four patients with a primary parotid malignancy were included in the study, with one bilateral case in this cohort. Patients were classified as stage I–II in 39 cases and stage III–IV in 26 cases. The five-year overall survival (OS), disease-specific survival (DSS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 78.4%, 89%, 92.5%, and 87.1%, respectively. Univariate analysis showed that high-risk histology, stage IV disease, lymphovascular invasion, perineural invasion, node metastasis, skin involvement, facial nerve involvement, and positive or close margins were risk factors associated with poorer outcomes. At present, the best evidence suggests that radical surgery should be the standard approach, and adjuvant therapy, in terms of radiotherapy/chemoradiotherapy, is recommended in patients with risk factors

Plasmonic Structures for Sensing and Emitting Devices

We report on the study of a plasmonic nanostructure that could be adopted as platform for emitting and sensing applications. Several devices have been prepared and characterized by atomic force microscopy (AFM) and Fourier transform micro-reflectance (FT- pR) techniques. In addition, a modelling via finite-difference time-domain (FDTD) simulations have been developed in order to interpret the morphological shape and the optical response of the considered structures. Until now, remarkable performances as surface plasmon resonance (SPR) based optical sensor have been founded. Moreover, we are performing preliminary trials in order to establish a coupling between photoluminescence (PL) features of suitable emitters with respect to the plasmonic resonances

Segmental Mandibulectomy and Mandibular Reconstruction with Fibula-Free Flap Using a 3D Template

Introduction: The present study evaluates the influence of virtual surgical planning with a preoperative 3D resin model on aesthetic and functional outcomes in patients treated by segmental mandibulectomy and reconstruction with fibula-free flap for oral cancer. Methods: All consecutive patients who underwent segmental mandibulectomy and mandibular reconstruction with a fibula-free flap using a 3D template at our department from January 2021 to January 2023 were included in the study. "Patients control" were patients treated by reconstruction with a fibula-free flap without using a 3D template. Three-dimensional modeling was performed by converting from preoperative computed tomography to a stereolithography format to obtain the resin 3D models. Qualitative analysis of anatomical and aesthetic results consisted of the evaluation of the patients' aesthetic and functional satisfaction and the symmetry of the mandibular contour observed at clinical examination. Quantitative analysis was based on the assessment of the accuracy and precision of the reconstruction by comparing preoperative and postoperative computed tomograms as objective indicators. Results: Seven patients (five males and two females, mean age of 65.1 years) were included in the study. All patients showed a symmetric mandibular contour based on the clinical examination. After recovery, six patients (85.7%) considered themselves aesthetically satisfied. The quantitative analysis (assessed in six/seven patients) showed that the mean difference between preoperative and postoperative intercondylar distance, intergonial angle distance, anteroposterior dimension, and gonial angle improved in the 3D template-assisted group. Conclusion: The 3D-printed template for mandibular reconstruction with microvascular fibula-free flap can improve aesthetic outcomes in comparison with standard approaches

An overview of Alpine and Mediterranean palaeogeography, terrestrial ecosystems and climate history during MIS 3 with focus on the Middle to Upper Palaeolithic transition

This paper summarizes the current state of knowledge about the millennial scale climate variability characterizing Marine Isotope Stage 3 (MIS 3) in S-Europe and the Mediterranean area and its effects on terrestrial ecosystems. The sequence of Dansgaard-Oeschger events, as recorded by Greenland ice cores and recognizable in isotope profiles from speleothems and high-resolution palaeoecological records, led to dramatic variations in glacier extent and sea level configuration with major impacts on the physiography and vegetation patterns, both latitudinally and altitudinally. The recurrent succession of (open) woodlands, including temperate taxa, and grasslands with xerophytic elements, have been tentatively correlated to GIs in Greenland ice cores. Concerning colder phases, the Greenland Stadials (GSs) related to Heinrich events (HEs) appear to have a more pronounced effect than other GSs on woodland withdrawal and xerophytes expansion. Notably, GS 9-HE4 phase corresponds to the most severe reduction of tree cover in a number of Mediterranean records. On a long-term scale, a reduction/opening of forests throughout MIS 3 started from Greenland Interstadials (GIs) 14/13 (ca. 55\u201348 ka), which show a maximum in woodland density. At that time, natural environments were favourable for Anatomically Modern Humans (AMHs) to migrate from Africa into Europe as documented by industries associated with modern hominin remains in the Levant. Afterwards, a variety of early Upper Palaeolithic cultures emerged (e.g., Uluzzian and Proto-Aurignacian). In this chronostratigraphic framework, attention is paid to the Campanian Ignimbrite tephra marker, as a pivotal tool for deciphering and correlating several temporal-spatial issues crucial for understanding the interaction between AMHs and Neandertals at the time of the Middle to Upper Palaeolithic transition