Improvement of mouth functional disability in systemic sclerosis patients over one year in a trial of fat transplantation versus adipose-derived stromal cells

Background. Systemic sclerosis (SSc) is a multisystem disease characterized by cutaneous and visceral fibrosis. Face and mouth changes include telangiectasia, sicca syndrome, and thinning and reduction of mouth width (microcheilia) and opening (microstomia). We applied autologous fat transplantation compared with autologous adipose-derived stromal cells (ADSCs) injection to evaluate the clinical improvement of mouth opening. Methods. From February to May 2013 ten consecutive SSc patients were enrolled from the outpatient clinic of Plastic Surgery Department of Sapienza University of Rome. Patients were divided into two groups as follows: 5 patients were treated with fat transplantation and 5 patients received infiltration of ADSCs produced by cell factory of our institution. To value mouth opening, we use the Italian version of Mouth Handicap in Systemic Sclerosis Scale (IvMHISS). Mouth opening was assessed in centimetres (Maximal Mouth Opening, MMO). In order to evaluate compliance and physician and patient satisfaction, we employed a Questionnaire of Satisfaction and the Visual Analogic Scale (VAS) performed before starting study and 1 year after the last treatment. Results and Conclusion. We noticed that both procedures obtained significant results but neither one emerged as a first-choice technique. The present clinical experimentation should be regarded as a starting point for further experimental research and clinical trials

Fluvial inverse modelling for inferring the timing of Quaternary uplift in the Simbruini range (Central Apennines, Italy)

The regional topography of the Central Apennines results from convergence between the African and Eurasian plates that led to the formation of a Neogene NE-verging imbricate fold and thrust belt. During the final stages of the orogenic deformations, the whole area was affected by strong uplift and by extensional faulting oriented along the main direction of the Apennine chain. In this framework, the landscape evolution in subaerial conditions started diachronically and is testified by the relicts of clastic deposit at different height from base levels of the present drainage network. In the Simbruini range, there are no absolute dating records neither of the most ancient clastic units deposited after the Messinian thrust-top facies nor of tectonic events. Trying to fill this gap, we used geomorphometric analyses to infer the timing of the recent phases of the tectonic history of the Simbruini range. Specifically, we identified the main non-lithological knickpoints along the river longitudinal profiles, clustered their altimetric distribution and correlated them with the levels of continental clastic deposits reserved at different elevations. Furthermore, we inferred the uplift history of the range by applying the inverse modelling of the river longitudinal profiles. Assuming a block uplift model, the drainage network cutting the Simbruini range recorded on average about 2.4 Myr of tectonic history, characterized by variable base level fall rates (corresponding to uplift rates). According the average tectonic history, the highest base level fall rate of 690 m My-1 was reached at 1.65 Ma, followed by the minimum of about 370 m My-1 , reached at 0.75 Ma, and by a second rise, up to a present-day value of 660 m My-1

Trattamento della contrattura capsulare da impianto protesico mammario. Nostra esperienza

La più comune complicanza in pazienti sottoposte ad intervento chirurgico di impianto protesico mammario è la contrattura capsulare. Non esiste, attualmente, un trattamento standard efficace per questa complicanza. Lo scopo del presente articolo è illustrare la nostra esperienza sull’uso degli antagosisti dei recettori per i leucotrieni nel trattamento della contrattura capsulare. I risultati mostrano che l’utilizzo di questi farmaci è in grado di ridurre il dolore e la distorsione della mammella in pazienti con un lungo decorso di contrattura capsulare

Paget extramammario: un caso clinico di Paget vulvare

Il Paget extrammammario è una patologia rara che generalmente colpisce la popolazione in età senile. Si può localizzare prevalentemente al livello della cute in regione ascellare, perineale e perianale, vulvare nelle donne e peniena nell’uomo. Istologicamente è una neoplasia intraepiteliale, caratterizzata dalla presenza delle cellule di Paget come la sua controparte mammaria, che è spesso associata a carcinoma duttale invasivo sottostante ed è generalmente considerata d’origine ghiandolare (ghiandola mammaria sottostante) e/o duttale. Il Paget extramammario, invece, è associato ad un carcinoma invasivo sottostante solo nel 25% dei casi e la sua patogenesi è controversa. Le pazienti con morbo di Paget vulvare sono a rischio per una seconda neoplasia sincrona o metacrona: l’adenocarcinoma del colon-retto, in particolare per localizzazione perianale, il carcinoma della cervice uterina, dell’utero, dell’ovaio, della vagina, dell'epitelio transizionale dalla pelvi renale all'uretra ed il carcinoma mammario. Il morbo di Paget vulvare rappresenta un’entità clinica ben definita e la più frequente fra le forme extramammarie, costituendo circa l’1% di tutte le neoplasie vulvari. La diagnosi si basa sulla presenza delle cellule di Paget nel contesto dell’epitelio, facilmente identificate all'esame istologico. La terapia della VPD prevede un’ampia escissione locale con una profondità di resezione tale da interessare tutti gli annessi cutanei. Nei casi in cui sia istologicamente dimostrata l'associazione con un adenocarcinoma sottostante invasivo o sia presente invasione stromale, occorre integrare l'approccio chirurgico vulvare alla linfoadenectomia inguino-femorale. Descriviamo il trattamento chirurgico di una paziente affetta da Paget vulvare, soffermandoci sul management clinico e i risultati ottenuti

Interplast Italy: A 20-year plastic and reconstructive surgery humanitarian experience in developing countries

BACKGROUND:: Interplast Italy is a nongovernment, nonprofit organization with the aim of providing high-quality standard reconstructive procedures, contributing to local medical and nursing education, in those countries where this is not available or where the local resources are inadequate to meet local needs. A recent debate about the real aim and the effectiveness of this kind of health support strategy in developing countries has been raised. METHODS:: The authors report a 20-year experience, explaining operative strategy, activities, and results, and contributing to the development and improvement of the philosophy of humanitarian missions. RESULTS:: Since 1988, 47 missions and 5235 operations have been performed. A total of 2286 patients (43.7 percent) were younger than 18 years, and 2949 (56.3 percent) were above that age. Congenital cleft deformity was the most common diagnosis in 2415 patients (46.13 percent). Patients suffering from postburn contractures were operated on in 1956 cases (37.36 percent). The number of postburn children operated on was 922 (17.6 percent). CONCLUSIONS:: Cooperation with local physicians is considered mandatory to guarantee adequate patient preselection, to organize the activity in situ, and to plan continuous effective work on a regular basis to build local capacity and facilitate sustainable models for health care. Furthermore, as local surgeons become interested in reconstructive surgery, continuous teaching through a multidisciplinary approach must be paramount. The activity of Interplast Italy contributed to building a plastic surgery service in Bangladesh. Combined multidisciplinary activities linked to established organizations such as the Interplast confederation are desirable to improve results. A link with structured organizations is needed to obtain financial resources to extend targets and to improve activities and outcomes

Interplast Italy: A 20-Year Plastic and Reconstructive Surgery Humanitarian Experience in Developing Countries

Background: Interplast Italy is a nongovernment, nonprofit organization with the aim of providing high-quality standard reconstructive procedures, contributing to local medical and nursing education, in those countries where this is not available or where the local resources are inadequate to meet local needs. A recent debate about the real aim and the effectiveness of this kind of health support strategy in developing countries has been raised. Methods: The authors report a 20-year experience, explaining operative strategy, activities, and results, and contributing to the development and improvement of the philosophy of humanitarian missions. Results: Since 1988, 47 missions and 5235 operations have been performed. A total of 2286 patients (43.7 percent) were younger than 18 years, and 2949 (56.3 percent) were above that age. Congenital cleft deformity was the most common diagnosis in 2415 patients (46.13 percent). Patients suffering from postburn contractures were operated on in 1956 cases (37.36 percent). The number of postburn children operated on was 922 (17.6 percent). Conclusions: Cooperation with local physicians is considered mandatory to guarantee adequate patient preselection, to organize the activity in situ, and to plan continuous effective work on a regular basis to build local capacity and facilitate sustainable models for health care. Furthermore, as local surgeons become interested in reconstructive surgery, continuous teaching through a multidisciplinary approach must be paramount. The activity of Interplast Italy contributed to building a plastic surgery service in Bangladesh. Combined multidisciplinary activities linked to established organizations such as the Interplast confederation are desirable to improve results. A link with structured organizations is needed to obtain financial resources to extend targets and to improve activities and outcomes. (Plast. Reconstr. Surg. 124: 1340, 2009.

Un raro caso di metastasi di carcinoma della mammella nella falange distale del primo dito del piede

Il carcinoma della mammella rappresenta il tumore maligno più frequente nelle donne. Le ossa rappresentano il primo sito di metastasi nel 26-50% dei casi. Nel 16% dei casi le metastasi coinvolgono gli arti. Presentiamo un rarissimo caso di una donna di 47 anni, sottoposta 8 anni prima a mastectomia radicale secondo Madden per carcinoma lobulare infiltrante multicentrico, che giungeva alla nostra osservazione per comparsa di edema, tumefazione, dolore e limitazione funzionale progressivamente ingravescenti della falange distale del primo dito del piede sinistro. Le immagini radiologiche dimostravano la presenza di aree osteolitiche e di rarefazione ossea. La paziente veniva sottoposta a biopsia della falange che dimostrava la presenza di tessuto neoplastico riferibile a metastasi di carcinoma della mammella