Iginio Tansini revisited

The origin of the muscolocutaneous latissimus dorsi flap dates back to 1906 when Igino Tansini, an Italian surgeon, described a procedure to reconstruct the mastectomy defect. After a detailed study of Tansini's original description and drawings, new insights about the pedicle of its compound flap have been found, showing that it has the same pedicle of the scapular flap. In the end, Tansini's flap should be more correctly considered as a compound musculocutaneous scapular flap

An improved method of supercharged transposed latissimus dorsi flap with the skin paddle for the management of a complicated lumbosacral defect

OBJECTIVE: Treatment of nonhealing wounds of lower back often poses a powerful challenge. We present one of the first report of treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle. CASE REPORT: We report a case of a 59 yearold man with myeloma of the sacral spine who underwent radiotherapy and chemotherapy and subsequently, laminectomies and placement of hardware for ongoing paresis and spine instability. Then, he developed an open wound and osteomyelitis of the spine with culture positive tuberculous granulomas. After multiple surgical debridement, he presented to our service and was treated with a single stage debridement followed by the performance of a latissimus dorsi musculocutaneous flap based on paraspinal perforators and supercharged. RESULTS: This solution, allowed for augmentation of blood flow to the muscle with the inferior gluteal artery, provided coverage of the defect resistant to the pressure, and simplified post-operative management of the patient. CONCLUSIONS: Alternative treatment options, including free tissue transfer, posed difficulties in finding suitable recipient vessels near the defect, in inserting the flap so as to restore its original length without compromising blood flow, and in postoperative care of the patient. Treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle may represent a milestone procedure for complicated lower spine wounds

A modified femtosecond laser technique for anterior capsule contraction syndrome

Anterior capsule contraction syndrome (ACCS) is a rare, late complication of cataract surgery, associated with impairment of visual function. In this paper, we describe a new surgical technique to treat ACCS by femtosecond laser procedure. The femtosecond laser was used to perform an anterior capsulotomy with a customized size, in order to avoid IOL damage. After ophthalmic viscosurgical device injection in the anterior chamber, the anterior capsule flap was separated from the IOL surface by gentle hydrodissection. This manoeuvre enabled an easy and safe removal of the fibrotic material by vitreal microscissors. Our technique allowed a complete removal of the fibrotic material and opening of the capsule, with immediate complete visual acuity recovery without IOL damage. In conclusion, femtosecond laser appears to be safe and effective for treatment of ACCS with long-lasting efficacy

Structure effects on reaction mechanisms in collisions induced by halo and weakly bound nuclei around the Coulomb barrier

The study of reaction mechanisms in collisions induced by halo and/or weakly bound nuclei around the Coulomb barrier has recently been the subject of many theoretical and experimental papers. Here we discuss our present understanding of some aspects of such a topic by briefly summarizing experimental data obtained by different authors with particular attention to some results obtained in the last years by our collaboration

Nuove strategie terapeutiche nel trattamento delle ferite difficili

Introduzione. Il trattamento medico-chirurgico delle ferite difficili rappresenta un problema socio-sanitario in continua crescita, colpendo attualmente nel nostro Paese circa 2.000.000 di persone. La “ferita difficile” non è altro che una perdita di sostanza cutanea, a patogenesi multifattoriale, che non tende alla guarigione in modo spontaneo. Numerosi studi presenti in letteratura hanno evidenziato che l’uso delle medicazioni avanzate consente di raggiungere migliori risultati clinici ed economici nel processo di guarigione delle ferite difficili, assicurando sia una permanenza superiore sulla lesione che accorciando il tempo di trattamento, in quanto viene richiesto un minor numero di applicazioni rispetto alle medicazioni tradizionali. La Wound Bed Preparation (WBP) può essere definita come la gestione globale e coordinata della lesione cutanea atta a rimuovere le barriere locali alla guarigione o a promuovere l’efficacia di misure terapeutiche innovative. La medicazione avanzata non è altro che un materiale di copertura che possiede caratteristiche di biocompatibilità. Scopo della medicazione avanzata è quello di creare l’ambiente ideale per il processo di cicatrizzazione isolando la ferita da eventuali traumi ed infezioni esterne. Pazienti e metodi. Nell’Ambulatorio “Ferite Difficili” della Cattedra di Chirurgia Plastica e Ricostruttiva del Policlinico Umberto I di Roma, dal gennaio al dicembre 2006, sono stati trattati 570 pazienti (308 uomini – 262 donne), con un’età variabile dai 2 giorni agli 85 anni, affetti da ulcere di varia natura. Nell’ambito dei nostri casi clinici sono stati selezionati 200 soggetti divisi casualmente in due gruppi: gruppo A - 100 pazienti trattati unicamente con medicazioni tradizionali; gruppo B - 100 pazienti trattati unicamente con medicazioni avanzate. Ogni paziente è stato trattato localmente con medicazioni periodiche, specifiche a seconda del tipo di ferita difficile presentata. Inoltre si è proceduto all’individuazione ed alla cura dei fattori sistemici, concause dell’ulcera. Il nostro protocollo prevedeva medicazioni due o tre volte alla settimana a seconda che si trattasse di ferite infette o non infette, per un periodo cha poteva variare da un mese per i casi meno gravi ad un anno per le forme croniche. Risultati. È risultata evidente una più alta percentuale di guarigione ottenuta attraverso l’utilizzo delle medicazioni avanzate. Nel Gruppo A si sono ottenuti i seguenti risultati: la guarigione del 53% delle ferite; il restante 47% non è guarito, ma nel 17%, le medicazioni sono state di ausilio alla preparazione del letto vascolare per l’esecuzione di un intervento definitivo (applicazione di innesti o lembi locali); nel rimanente 30%, invece, è stato ottenuto solo un modestissimo miglioramento della lesione che è ancora in fase di trattamento. Nel Gruppo B si è ottenuta la guarigione del 65% delle ferite; nel restante 35% non guarito, nel 15% le medicazioni sono state di ausilio alla preparazione del letto vascolare per l’esecuzione di un intervento definitivo (applicazione di innesti o lembi locali) mentre nel rimanente 20% si è raggiunto comunque un notevole miglioramento della lesione (con riduzione delle dimensioni, scomparsa dell’infezione e miglioramento della qualità di vita del paziente). Discussione e conclusioni. In sintesi, emerge che le medicazioni avanzate, se correttamente impiegate, offrono vantaggi in termini di efficacia clinica (velocità di guarigione della lesione), di qualità della vita del paziente e di economicità. Non ultimo è da considerare che la ferita difficile è spesso l’epifenomeno di una malattia sistemica. La ferita difficile richiede, quindi, un trattamento multidisciplinare. difficile richiede, quindi, un trattamento multidisciplinare. Results. The results showed a higher percentage of recovery reached by using the advanced dressings. Group A showed the followings results: the 53% of patients recovered from wounds; the remaining 47% patients did’nt not recover but in 17% cases medications showed to be of some help in the preparation of the vascular bed for the execution of a definitive operation (application of grafts or local edges), while the remaining 30% has shown a scarce improvement of the injury and they are still under treatment. Group B showed the 65% of patients recovered from wounds; as for the remaining 35% not recovered patients, medications represented an auxiliary aid to the preparation of the vascular bed for the execution of a definitive operation (application of grafts or local edges) for the 15% of patients, while the remaining 20%, even if not completely recovered, showed a notable improvement of the injury (reduction of the dimensions and disappearance of the infection and improvement of the patient quality of life). Conclusions. In synthesis, it emerges that the advanced dressings, if correctly used, offer advantages in terms of clinical effectiveness (rapid recovery from the injury), patient quality of the life and cheapness. It has also to be considered that the difficult wound is often the epiphenomenon of a systemic illness. The difficult wound requires, therefore, a multidisciplinary treatment

Isolated, Massive Supergiants near the Galactic Center

We have carried out a pilot project to assess the feasibility of using radio, infrared, and X-ray emission to identify young, massive stars located between 1 and 25 pc from the Galactic center. We first compared catalogs compiled from the Very Large Array, the Chandra X-ray Observatory, and 2MASS. We identified two massive, young stars: the previously-identified star that is associated with the radio HII region H2, and a newly-identified star that we refer to as CXOGC J174516.1-290315. The infrared spectra of both stars exhibit very strong Br-gamma and He I lines, and resemble those of massive supergiants that have evolved off of the main sequence, but not yet reached the Wolf-Rayet phase. We estimate that each star has a bolometric luminosity >10^6 L_sun. The detection of these two sources in X-rays is surprising, because stars at similar evolutionary states are not uniformly bright X-ray sources. Therefore, we suggest that both stars are in binary systems that contain either OB stars whose winds collide with those of the luminous supergiants, or compact objects that are accreting from the winds of the supergiants. We also identify X-ray emission from a nitrogen-type Wolf-Rayet star and place upper limits on the X-ray luminosities of three more evolved, massive stars that previously have been identified between 1 and 25 pc from Sgr A*. Finally, we briefly discuss the implications that future searches for young stars will have for our understanding of the recent history of star formation near the Galactic center. (abridged)Comment: 9 pages, including 8 figures. Submitted to ApJ, and modified in response to referee's repor

Stabilization of fault slip by fluid injection in the laboratory and in situ

Faults can slip seismically or aseismically depending on their hydromechanical properties, which can be measured in the laboratory. Here, we demonstrate that fault slip induced by fluid injection in a natural fault at the decametric scale is quantitatively consistent with fault slip and frictional properties measured in the laboratory. The increase in fluid pressure first induces accelerating aseismic creep and fault opening. As the fluid pressure increases further, friction becomes mainly rate strengthening, favoring aseismic slip. Our study reveals how coupling between fault slip and fluid flow promotes stable fault creep during fluid injection. Seismicity is most probably triggered indirectly by the fluid injection due to loading of nonpressurized fault patches by aseismic creep

First optical validation of a Schwarzschild Couder telescope: the ASTRI SST-2M Cherenkov telescope

The Cherenkov Telescope Array (CTA) represents the most advanced facility designed for Cherenkov Astronomy. ASTRI SST-2M has been developed as a demonstrator for the Small Size Telescope in the context of the upcoming CTA. Its main innovation consists in the optical layout which implements the Schwarzschild-Couder configuration and is fully validated for the first time. The ASTRI SST-2M optical system represents the first qualified example for two mirrors telescope for Cherenkov Astronomy. This configuration permits to (i) maintain a high optical quality across a large FoV (ii) de-magnify the plate scale, (iii) exploit new technological solutions for focal plane sensors. The goal of the paper is to present the optical qualification of the ASTRI SST-2M telescope. The qualification has been obtained measuring the PSF sizes generated in the focal plane at various distance from the optical axis. These values have been compared with the performances expected by design. After an introduction on the Gamma Astronomy from the ground, the optical design and how it has been implemented for ASTRI SST-2M is discussed. Moreover the description of the setup used to qualify the telescope over the full field of view is shown. We report the results of the first--light optical qualification. The required specification of a flat PSF of $\sim 10$ arcmin in a large field of view ~10 deg has been demonstrated. These results validate the design specifications, opening a new scenario for Cherenkov Gamma ray Astronomy and, in particular, for the detection of high energy (5 - 300 TeV) gamma rays and wide-field observations with CTA.Comment: 6 pages, 5 figure