Experimental analysis about the evaluation of tungsten carbide-bur, piezoelectric and laser osteotomies.

Aim: Osteotomies are performed in oral surgery with five kinds of cutting instruments: 1) burs (Tungsten carbide cylindric burs), 2-3) ultrasound Piezosurgery (type I and II), 4-5) and lasers (Er:YAG; Er,Cr:YSGG). This study compares the quality of cutting of every single instruments, evaluating accuracy (length, thickness, depth and morphology), velocity (number of passages and time) and entity of damage. Methods: In vitro experiments with ten osteotomies were performed on one-hundred of cow ribs with each instrument. In vivo surgery was performed on New Zealand white rabbit: two osteotomies are made with all instruments on the mandible and on the shinbone, totalizing four osteotomies for each instrument. Samples are processed to be evaluated through histological exam at stereomicroscopy Discussion: Results show a statistically significant variability on "thickness" (p value=0.001), "time" (p value=0.001), "depth" and penetration speed (p-value=0.001; p-value=0.001) and the "number of passages" (p-value=0.001). No differences have been observed in "length" (p-value=0.078). Histological analysis reveals that osteotomy performed with laser and Piezosurgery II generates major damage to osteocytes near cutting surfaces. Conclusion: Currently, purchase and management elevated costs, minor versatility of use, and long training times for equipments such as Piezosurgery and laser limit their general use, but remain advantageous in case of risky interventions near noble structures. Choice of device depends on experience maturated by operator in time, characteristics of operation and patient's clinical conditions

Kidney transplantation from living donor with monolateral renal artery fibromuscular dysplasia using a cryopreserved iliac graft for arterial reconstruction: a case report and review of the literature

Background Aging and mortality of patients on waiting lists for kidney transplantation have increased, as a result of the shortage of organs available all over the world. Living donor grafts represent a significant source to maintain the donor pool, and resorting successfully to allografts with arterial disease has become a necessity. The incidence of renal artery fibromuscular dysplasia (FMD) in potential living renal donors is reported to be 2-6%, and up to 4% of them present concurrent extra-renal involvement. Case presentation We present a case of renal transplantation using a kidney from a living donor with monolateral FMD. Resection of the affected arterial segment and its subsequent replacement with a cryopreserved iliac artery graft from a deceased donor were performed. No intraoperative nor post-operative complications were reported. The allograft function promptly resumed, with satisfying creatinine clearance, and adequate patency of the vascular anastomoses was detected by Doppler ultrasounds. Conclusion Literature lacks clear guidelines on the eligibility of potential living renal donors with asymptomatic FMD. Preliminary assessment of the FMD living donor should always rule out any extra-renal involvement. Whenever possible, resection and reconstruction of the affected arterial segment should be taken into consideration as this condition may progress after implantation

Prognostic value of specific KRAS mutations in patients with colorectal peritoneal metastases

Background: There is little evidence on KRAS mutational profiles in colorectal cancer (CRC) peritoneal metastases (PM). This study aims to determine the prevalence of specific KRAS mutations and their prognostic value in a homogeneous cohort of patients with isolated CRC PM treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Materials and methods: Data were collected from 13 Italian centers, gathered in a collaborative group of the Italian Society of Surgical Oncology. KRAS mutation subtypes have been correlated with clinical and pathological characteristics and survival [overall survival (OS), local (peritoneal) disease-free survival (LDFS) and disease-free survival (DFS)]. Results: KRAS mutations occurred in 172 patients (47.5%) out of the 362 analyzed. Two different prognostic groups of KRAS mutation subtypes were identified: KRASMUT1 (G12R, G13A, G13C, G13V, Q61H, K117N, A146V), median OS > 120 months and KRASMUT2 (G12A, G12C, G12D, G12S, G12V, G13D, A59E, A59V, A146T), OS: 31.2 months. KRASMUT2 mutations mainly occurred in the P-loop region (P < 0.001) with decreased guanosine triphosphate (GTP) hydrolysis activity (P < 0.001) and were more frequently related to size (P < 0.001) and polarity change (P < 0.001) of the substituted amino acid (AA). When KRASMUT1 and KRASMUT2 were combined with other known prognostic factors (peritoneal cancer index, completeness of cytoreduction score, grading, signet ring cell, N status) in multivariate analysis, KRASMUT1 showed a similar survival rate to KRASWT patients, whereas KRASMUT2 was independently associated with poorer prognosis (hazard ratios: OS 2.1, P < 0.001; DFS 1.9, P < 0.001; LDFS 2.5, P < 0.0001). Conclusions: In patients with CRC PM, different KRAS mutation subgroups can be determined according to specific codon substitution, with some mutations (KRASMUT1) that could have a similar prognosis to wild-type patients. These findings should be further investigated in larger series

Calvarial Bone Grafts and Temporalis Muscle Flap for Midfacial Reconstruction After Maxillary Tumor Resection: A Long-term Retrospective Evaluation of 17 Patients.

Midfacial reconstruction after radical oncological resection is a challenging endeavor and several options can be employed: prosthethic devices, pedicled flaps (with or without the aid of autologous or alloplastic grafts), and microvascular flaps. Each technique has specific indications, advantages and disadvantages.The use of traditional surgical reconstructive procedures seems to be shifted nowadays by microvascular free flaps. Nevertheless, in our experience the myofascial temporalis flap associated with free calvarial bone grafts demonstrate to be a safe and versatile option in primary midfacial reconstruction. From this point of view the authors have developed a technique for one-stage reconstruction of the orbito-maxillary skeleton and soft tissues and without the use of microsurgical flaps; this surgical procedure can be used only on patients for whom a resection of the cutaneous tissues and exenteratio orbitae are not necessary. The aims of this paper is to describe the surgical technique and to show a retrospective analysis on 17 patients which underwent midfacial radical resection and immediate reconstruction with calvarial bone grafts and temporalis muscle flap along 15 years

Orbital Fractures: a New Classification and Staging of 190 Patients

none4The orbit is located in the middle third of the face, composed of several bones and surrounded by complex anatomic structures so that orbital fractures (OF) often involve other parts of the face. A staging system for classifying OF is of paramount importance in order to exchange information between trauma centers. Several classifications have been proposed for describing OF but they have not a single method applicable to the whole orbit. Here, a classification for OF that can be summarized with four abbreviations is proposed. Four letters define the localization (F = frontal, N = nasal, M = maxillary and Z = zygomatic bone fracture), two acronyms describe fragment shift (in = blow-in or out = blow-out), four numbers define ocular movement impairment (1 = superior, 2 = internal, 3 = inferior, and 4 = external extrinsic muscular deficit) and two acronyms describe eye position (EX = exophthalmos and ENO = enophthalmos). To evaluate the suitability of the proposed classification a retrospective study on a series of 190 OFs is performed. Age, gender, new stage, clinical diagnosis at admission, type of surgery, and need for graft for orbital reconstruction are considered. A good correlation between the proposed classification and the studied variables is detected. In conclusion, the proposed classification is a simply and precise method to stage OF. It can summarize OF and be used in the daily practice. However, it is our belief that a multi-center study should be performed before the effectiveness of the proposed classification can be clearly stated.noneF. CARINCI; ZOLLINO I; BRUNELLI G; CENZI RCarinci, Francesco; Zollino, Ilaria; Brunelli, G; Cenzi, R

Clinical outcome of 285 Medpor grafts used for craniofacial reconstruction

Porous polyethylene (Medpor) is an alloplastic material worldwide used for craniofacial reconstruction. To evaluate complications and risk factors associated with this synthetic graft, a retrospective study was performed. A series of 285 Medpor grafts were placed in 187 patients. Age, sex, diagnosis at admission, site, type of surgical insertion, type of fixation, and outcome (no complications, anesthesia, exposure, infection, and implant remodeling and removal) are considered. By means of univariate and multivariate analyses, we detect variables most associated with poor outcome. Univariate analysis showed that graft "survival" curves stratified according to (1) diagnosis at admission and (2) site are statistically significant. Subsequently, a Cox analysis was performed: both variables are also predictors of graft outcome. Porous polyethylene is a reliable alloplastic material that can be satisfactory used for craniofacial reconstruction. However, some sites (i.e., nose, maxilla, and ear) and diagnosis at admission (i.e., syndromic patients previously operated) are related to an higher risk of implant failure

Imaging of biliary and vascular complications

With the aid of numerous high-quality illustrations, this volume explains the strengths and limitations of the different techniques employed in the imaging of pancreatitis. Ultrasound, computed tomography, magnetic resonance imaging and interventional imaging are each considered separately in the settings of acute and chronic pancreatitis. A further section is devoted to imaging of the complications of these conditions. Throughout, care has been taken to ensure that the reader will achieve a sound understanding of how the imaging findings derive from the pathophysiology of the disease processes. The significance of the imaging findings for clinical and therapeutic decision making is clearly explained, and protocols are provided that will assist in obtaining the best possible images

Mandibular condyle fractures: evaluation of the Strasbourg Osteosynthesis Research Group classification.

Condylar fractures (CFs) are about 30\% of mandibular fractures. Condylar fractures are treated with several protocols, and unsatisfying outcome is achieved in some cases. A staging system for classifying CFs is of paramount importance to plan therapy, to define prognosis, and to exchange information among trauma centers. The Strasbourg Osteosynthesis Research Group proposed a classification system for CFs, but no report focusing to its effectiveness is still available. Thus, we performed a retrospective study on a series of patients affected by CFs.The Strasbourg Osteosynthesis Research Group classification defines 3 main types of CFs: diacapitular fracture (i.e., through the head of the condyle [DF]), fracture of the condylar neck, and fracture of the condylar base (CBF). A series of 66 patients (and 84 CFs) was evaluated, and age, sex, clinical diagnosis at admission, treatment, and outcome were considered.Fractures of the condylar base and DFs are the most (52.4\%) and the least (4.8\%) frequent fractures, respectively. Conversely, associated fractures of the facial skeleton are found in most cases of DFs (75\%) and in few cases of CBFs (20.5\%). Surgery was performed in about 15\% of all cases: no DF was operated, whereas fractures of the condylar neck and CBFs have an open reduction and an internal rigid fixation in 57\% and 43\%, respectively. Postsurgical and late sequelae were 22.3\% and 19\%. Temporomandibular joint symptoms and malocclusion cover about 80\% and 90\% of postsurgical and late sequelae.The new classification is a simple method to define CFs and can give some elements about the prognosis