Complications following non-surgical aesthetic treatments in hiv+ patients receiving antiretroviral therapy: A 12-years experience

Since the advent of HIV antiretroviral therapies at the end of the 20th century, the morbidity and mortality rates associated with HIV infection have decreased dramatically. Unfortunately, these benefits are associated with substantial morphologic changes in the body, such as abnormal fat distribution with peripheral lipohypertrophy and facial lipoatrophy. Facial wasting is considered the major stigma for HIV–infected people and may result in reduced antiretroviral adherence. Patients suffering from the stigmata of HIV infection can benefit from non-surgical aesthetic treatments performed with fillers or lipolytic agents that provide a quick and reliable service for facial rejuvenation, with high patient satisfaction and a low risk of complications. In the present paper, a retrospective analysis of complications following non-surgical aesthetic treatments (calcium hydroxyapatite-based filler, hyaluronic acid filler, polyacrylamide hydrogel filler and dehoxycholic acid injections), in a cohort of 116 consecutive HIV+ patients, treated over a period of 12 years, was performed. With the exception of the tardive swelling reported after calcium hydroxyapatite injections, complications were recorded just after polyacrylamide hydrogel treatment as small, palpable, nonvisible nodules or aseptic abscess. Our experience is consistent with those already published in the literature and the complication rate seems to be comparable to non-infected patients

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

Background: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3–0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. Methods: Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. Results: Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. Conclusions: The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures

Ethnicity based variation in expression of E-cadherin in patients with squamous cell carcinoma of the oral tongue

The oral tongue is the most common site for tumours within the oral cavity. Despite intense research, there has been no improvement in the survival rate for patients with oral tongue squamous cell carcinoma (OTSCC) during the last decades. Differences between oral cancer patients based on ethno-geographical distribution have been reported. The present study used immunohistochemistry to evaluate commonly used markers of cancer cell phenotypes, E-cadherin, β-catenin and cytokeratins 5 and 19, in 120 patients with OTSCC. To evaluate the impact of ethnicity, patients from Sweden and Italy were included. A higher proportion of Swedish patients exhibited high expression of E-cadherin in their tumours (P=0.039), and high levels of E-cadherin in Swedish OTSCC patients that had succumbed to their disease were associated with poor prognosis. These data demonstrated differences in the pathological characteristics of OTSCC between two different European populations. The findings emphasise the need to take ethnicity/geographical location of patients into account when comparing results from different studies of OTSCC

Restructuring surgical training after COVID-19 pandemic: A nationwide survey on the Italian scenario on behalf of the Italian polyspecialistic young surgeons society (SPIGC)

Introduction: The COVID-19 pandemic has led to the disruption of surgical training. Lack of communication, guidelines for managing clinical activity as well as concerns for safety in the workplace appeared to be relevant issues. This study aims to investigate how surgical training has been reorganized in Italy, almost 2 years after the outbreak of COVID-19 pandemic. Materials and methods: A 16-item-electronic anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of different sections concerning demographic characteristics and impacts of the second COVID-19 pandemic wave on surgical and research/didactic activities. Changes applied in the training programme and activities carried out were also investigated. The survey was carried out in the period between June and October 2021. Results: Four hundred and thirty responses were collected, and 399 were considered eligible to be included in the study analysis. Three hundred and thirty-five respondents continued working in Surgical Units, with a significant reduction (less than one surgical session per week) of surgical sessions in 49.6% of them. With concern to didactic and research activities, 140 residents maintained their usual activity, while 116 reported a reduction. A sub-group analysis on resident moved to COVID-19 departments showed a reduction of research activities in 35% of them. During the period considered in this survey, the surgical training program was not substantially modified for most of participants (74.6%). Conclusion: Our survey demonstrated that surgical residency programs haven't improved 2 years after the beginning of the pandemic. Further improvements are needed to guarantee completeness of surgical training, even in emergency conditions

A modified graftless sinus lift: case report

Aim: AAA (Alveolar Antral Artery) injuries are the most frequent intra-operative lesions occurring during maxillary sinus surgery. The aim of this work is to evaluate the role of preoperative CBCT and the effectiveness of piezosurgery to prevent bleeding. Furthermore, a modified Lundgren technique is presented, that can significantly reduce the risk of bleeding and of damages to maxillary sinus structures. Methods: A case of maxillary sinus lift with immediate implants placement is reported. Preoperative CBCT scan allowed to study the course in the anterior-lateral sinus wall of the AAA and the variability of its patency. Antrostomy was performed with piezosurgery device. Results: Through preoperative identification of the course of the artery and trough this modified piezosurgery technique, it was possible to preserve membrane and artery integrity. Schneider membrane therefore was detached from the sinus floor, and contextually three implants were positioned. Conclusions: In the preoperative phase, a study with CBCT scan is suggested, in order to identify intraosseous arterial course, patency variability and the distance from alveolar ridge. Furthermore, it is strongly recommended the use of piezosurgery, to preserve vascular structures and soft tissues. A modified Lundgren technique can be useful to avoid the use of round bur and thus reduce the risk of perforation of the underlying structures.Aim AAA (Alveolar Antral Artery) injuries are the most frequent intra-operative lesions occurring during maxillary sinus surgery. The aim of this work is to evaluate the role of preoperative CBCT and the effectiveness of piezosurgery to prevent bleeding. Furthermore, a modified Lundgren technique is presented, that can significantly reduce the risk of bleeding and of damages to maxillary sinus structures.Methods A case of maxillary sinus lift with immediate implants placement is reported. Preoperative CBCT scan allowed to study the course in the anterior-lateral sinus wall of the AAA and the variability of its patency. Antrostomy was performed with piezosurgery device.Results Through preoperative identification of the course of the artery and trough this modified piezosurgery technique, it was possible to preserve membrane and artery integrity. Schneider membrane therefore was detached from the sinus floor, and contextually three implants were positioned.Conclusions In the preoperative phase, a study with CBCT scan is suggested, in order to identify intraosseous arterial course, patency variability and the distance from alveolar ridge. Furthermore, it is strongly recommended the use of piezosurgery, to preserve vascular structures and soft tissues. A modified Lundgren technique can be useful to avoid the use of round bur and thus reduce the risk of perforation of the underlying structures

Displacement of Dental Implants Into the Maxillary Sinus: A Retrospective Study of Twenty-One Patients

Background: One possible complication of implant surgery in the posterior maxilla is the displacement of implants into the maxillary sinus. Purpose: To report on clinical and radiological findings and on biological, surgical, and biomechanical considerations in cases of implant displacement. Materials and Methods: This is a retrospective study of 21 patients referred to the Department of Head and Neck Surgery, Second University of Naples, due to implants displaced into the maxillary sinus. Patient, implant, and treatment data were collected, and 1-year follow-up was made. Results: A total of 24 displaced implants were diagnosed and surgically removed through an antrostomy in the lateral sinus wall. Implant displacement occurred after functional loading in only one case; in the remaining cases, displacement occurred either perioperatively or postoperatively prior to loading. Besides the displacement, eight patients suffered from maxillary sinusitis, treated with a Caldwell-Luc operation. Healing was uneventful for all patients, and no sinusitis relapse or late postoperative complication was present at 1-year follow-up. Conclusions: It is reasonable to affirm that the major cause of displacement of implants is related, most of the time, to incorrect treatment planning and/or a poorly performed surgical procedure. When implant displacement occurs, the displaced foreign body has to be removed in order to avoid sinus pathology

HelpMe!: a Serious Game for Rehabilitation of Children affected by CVI

CVI (Cerebral Visual Impairment) is the leading cause of visual impairment in the United States and the Western Europe. Due to the high number of different inabilities that children could have when affected by CVI, it is crucial for the rehabilitation process to start from a good assessment, especially at early ages. In this paper we present HelpMe!, a serious game to improve the rehabilitation process for these children with a system able to adapt the exercises to each particular child and to his/her improvements. The system integrates an eye tracker system to correctly measure the performances of the child and his/her capability to watch and touch a moving object at the same time