Strategie ricostruttive della zona d'appoggio del piede nei traumi dell'arto inferiore

La copertura delle perdite di sostanza del piede, in particolare della zona d’appoggio, tallone e avampiede, ha sempre rappresentato un grosso problema per il chirurgo ricostruttore. Le particolarità anatomiche e funzionali di queste regioni spiegano l’enorme numero di tecniche utilizzate e le divergenze d’opinione relative alla ricostruzione delle regioni anatomiche portanti. Lo sviluppo della microchirurgia, l’avvento dei lembi liberi negli anni ’70, nonché la descrizione di numerosi lembi loco-regionali muscolo-cutanei o a flusso retrogrado, hanno considerevolmente migliorato la prognosi delle perdite di sostanza del piede. Infine la piu’ recente descrizione di lembi, sia liberi che locali, basati sui vasi perforanti hanno ulteriormente contribuito al trattamento di queste lesioni, riducendo al minimo le sequele legate al sito donatore. Attualmente il chirurgo plastico dispone dunque di molteplici soluzioni per la copertura delle perdite di sostanza di questa regione. L’obiettivo di questo studio è quello di analizzare i mezzi di copertura della zona d’appoggio del piede utilizzati in un periodo di 20 anni, di precisare l’evoluzione nel tempo dei mezzi utilizzati, al fine di meglio definire le indicazioni chirurgich

Strategie ricostruttive della zona d'appoggio del piede nei traumi dell'arto inferiore

La copertura delle perdite di sostanza del piede, in particolare della zona d’appoggio, tallone e avampiede, ha sempre rappresentato un grosso problema per il chirurgo ricostruttore. Le particolarità anatomiche e funzionali di queste regioni spiegano l’enorme numero di tecniche utilizzate e le divergenze d’opinione relative alla ricostruzione delle regioni anatomiche portanti. Lo sviluppo della microchirurgia, l’avvento dei lembi liberi negli anni ’70, nonché la descrizione di numerosi lembi loco-regionali muscolo-cutanei o a flusso retrogrado, hanno considerevolmente migliorato la prognosi delle perdite di sostanza del piede. Infine la piu’ recente descrizione di lembi, sia liberi che locali, basati sui vasi perforanti hanno ulteriormente contribuito al trattamento di queste lesioni, riducendo al minimo le sequele legate al sito donatore. Attualmente il chirurgo plastico dispone dunque di molteplici soluzioni per la copertura delle perdite di sostanza di questa regione. L’obiettivo di questo studio è quello di analizzare i mezzi di copertura della zona d’appoggio del piede utilizzati in un periodo di 20 anni, di precisare l’evoluzione nel tempo dei mezzi utilizzati, al fine di meglio definire le indicazioni chirurgich

Surgical management of the glomus tumors of the fingers: a single center experience

Introduction: Glomus tumors are rare neoplasms arising from the subcutaneous glomus apparatus. They account for 1 – 5% of the soft tissue tumors of the upper extremity, occurring in most cases in the nail bed. The typical clinical presentation includes paroxysmal pain and hypersensitivity to cold which limit the use of the affected hand causing practical, professional and often emotional discomfort for the patient. Materials and Methods: Four patients with finger glomus tumor were treated in our institution in the last 30 years. Three patients had a right hand tumor (1st, 3rd and 4th finger) and one patient a left hand tumor (2nd finger). Three tumors were placed in the nail bed and one in the finger tip. In all cases duplex ultrasonography was employed preoperatively and during surgery to ensure complete resection of the tumor. All patients underwent surgical excision of the tumor with local block anesthesia. Results: Intense point pain and hypersensitivity to cold was observed in all cases (100%). Two out of 4 patients (50%) presented an irradiation of the pain at the ipsilateral arm and shoulder. Surgical procedure was performed successfully in all cases, with total excision of the tumor and no intraoperative or postoperative complications. No recurrences occurred. Conclusions: Diagnosis of glomus tumors of the fingers is generally easy when manifested with the classical clinical picture and duplex ultrasonography is employed. Complete surgical excision is curative, providing immediate relief of symptoms and improvement of eventual professional or psychological discomfort

Multimodality approach to malignant pleural mesothelioma: a case report

Introduction: We report a case of diffuse malignant pleural mesothelioma (DMPM) in a 68 years old male patient who was admitted for right sited pleural effusion. The patient was treated by multimodality approach consisting in surgical treatment with Extrapleural Pleuropneumonectomy followed by chemotherapy with Cisplatin and Pemetrexed. He had a disease free period of one year and survived for 31 months. Case report: The patient was admitted to our Institute for a right sited pleural effusion diagnosed on chest X ray. Anamnesis revealed professional asbestos exposure and the patient presented dyspnea, dry cough, right sited chest pain, low fever and loss of weight. As thoracentesis and CT scan did not reveal pathological findings except of the effusion, we performed videothoracoscopy. Several grey nodular lesions involving the costal, diaphragmatic and mediastinic parietal pleural sheets were found. Histological examination of the specimens extracted revealed the presence of epithelial malignant pleural mesothelioma with sarcomatoid areas. Further examinations staged the lesion as Butchart I. Extrapleural pleuropneumonectomy was performed followed by a chemiotherapic treatment with Cisplatin and Pemetrexed. The patient underwent a follow up program with CT scan every four months. The disease free period was of about one year and the patient died after 31 months from diagnosis for septic complications related to chronic effusion. Discussion: Single treatments do not demonstrate an acceptable efficacy on the treatment of DMPM. Multimodality therapy provides good survival improvement and acceptable quality of life for the patients

Randomized prospective study on the efficacy of a new revitalizing filler composed of hyaluronic acid (Wipeline).

AIM: The aim of the study was to test the efficacy of a new revitalizing filler (Wipeline) formed by a buffer physiological solution of hyaluronic acid (HA). METHODS: A prospective study was performed on 100 patients (aging between 40 and 70 years), with clear signs of premature facial aging. Patients were randomly assigned to two groups, one treated with a HA concentration of 1.6%, the other with a concentration of 2% in the tested product. The treatment protocol consisted of three sessions with a four weeks intervals between them. Visual Analogue Scale (VAS) and digital photos were used to evaluate results after 1, 3, 6 and 12 months from treatment end. RESULTS: An improvement of turgidity, elasticity and luminosity of the skin and a reduction of folds and wrinkles of the treated areas were observed in both groups. The higher concentrated solution of HA had a more prolonged effect and a greater filling effect. Products were well tolerated and no adverse reactions observed. CONCLUSION: The efficacy of Wipeline has been clinically supported. This revitalizing filler succeeded in increasing skin elasticity and tone by dermal hydration. The procedure is simple and little invasive. It represents a good treatment option to restore vitality and turgidity of skin presenting the signs of aging

I Carcinomi in situ della mammella: inquadramento clinico ed attualità

INTRODUCTION: Lobular and ductal carcinomas in situ of the breast (LCIS and DCIS) origin from the ductal-lobular unit of mammary gland, but they are characterized for different morphologic patterns and evolution. In 1980 they represent 1.4% of diagnosis in breast biopsy, less of 5% of carcinomas of the breast. Actually in 7.5% of breast biopsy an in situ carcinoma is recognized (approximating 40% of breast cancers). Our purpose is to evaluate the different available strategies in the clinic management of DCIS and LCIS and, in case of surgical treatment, which reconstructive approach obtains satisfactory breast conformation.MATERIALS AND METHODS: The study enclose 125 patients: 40 of them presented LCIS (32%) and 85 DCIS (68%). In 40 patients (32%) underposed to mastectomy was performed a reconstruction in cooperation with aesthetic surgeons. 35 of 40 women with LCIS are included in a follow-up programme, 5 of them had a bilateral mastectomy and reconstruction. RESULTS: No recurrences were observed in patients affected by LCIS. Six patients underposed to wide excision for DCIS developed local recurrence, treated by mastectomy. No recurrences were observed in patients treated initially with mastectomy. Some complications correlated to reconstruction were detected. CONCLUSIONS: One of most controversial sights in breast pathology is the understanding of biological meaning of CLIS: in facts CDIS can be considered a pre-invasive cancer, CLIS is reasonably considerable only a risk indicator for developing breast cancer but it isn’t a pre-neoplastic lesion. Very important is the reconstruction of the breast to improve the quality life of patients

Trattamento chirurgico del paziente con gozzo tiroideo immerso

Il gozzo è una delle patologie che più frequentemente colpiscono la tiroide. Mentre il termine gozzo è universalmente accettato, non altrettanto accade per il termine “immerso” in quanto non esiste univocità sul livello che la tiroide tumefatta deve raggiungere all’interno del torace per poter essere considerata “immersa”. La tendenza dei gozzi immersi di ingrandirsi e di comprimere strutture anatomiche adiacenti e la possibilità di trasformazione maligna, hanno imposto l’asportazione chirurgica come trattamento di scelta. Presentiamo in questo lavoro, partendo dalla nostra esperienza, una revisione della letteratura sul management chirurgico del gozzo tiroideo immerso

Le Sequele funzionali dopo chirurgia del retto basso

INTRODUCTION: The treatment of colorectal cancer has changed radically in the last decades. Due to the great advances it is now often possible to subject patients to oncological radical treatments without applying to highly aggressive surgery, such as the Miles abdomino perineal resection, which requires a definitive colostomy. So nowadays we more and more apply to anterior resection of the rectum. Some recent studies about quality of life in patients who underwent anterior resection of the rectum focalized their attention on postoperative functional sequels. In particular incontinence, constipation, obstructed defecation and urgency are some of the symptoms which define the anterior resection syndrome, which can be efficiently treated by electrostimulation and biofeedback. MATERIALS AND METHODS: A prospective study on 61 patients who underwent between 2002 and 2007 anterior resection of the rectum with total mesorectal excision for adenocarcinoma, has shown symptoms of anterior resection syndrome in 14 patients. Succeeding treatment with sphincter electrostimulation and biofeedback has shown improvement in all patients and complete resolution of the anterior resection syndrome in 10 patients who showed a great compliance and a steady improvement on quality of life. DISCUSSION AND CONCLUSIONS: Rehabilitative treatment with electrostimulation and biofeedback can sensibly reduce symptoms of anterior resection syndrome. An accurate manometric functional assessment is necessary before starting treatment with electrostimulation and biofeedback

Conservative management of minor anastomotic leakage after open elective colorectal surgery

Introduction: The utility of prophylactic drainage in colorectal surgery is controversial. The aim of the present article is to study the role of drainage tubes on the management of minor anastomotic dehiscences. Patients and Methods: We retrospectively review clinical reports of 18 consecutive patients with anastomotic dehiscence after open elective colorectal surgery. The mean age was 63 years and the male – female ratio was 5:1. Nine (50%) patients underwent re-operation for fecal peritonitis (group A) while the remaining nine (50%) were managed conservatively (group B). The parameters evaluated in both groups were: time of the anastomotic breakdown, clinical findings, amount of fluid drained the day of the dehiscence, diagnostic means used, length of stay and mortality. Results: Anastomotic leakages were observed medially after 3,6 days from surgery in group A and after 5.6 days in group B. The most frequent clinical manifestations were: fecal material through the tubes (88.9%), pelvic pain (88.9%) and fever (77.8%). Patients in group A had a median faecal fluid flow of 235cc the day of the dehiscence and 130cc those in group B. Imaging was employed only in three cases in group A and in all cases in group B. The length of hospital stay was longer in patients treated surgically: 37 days versus 29 in those treated conservatively. Conclusions: Minor anastomotic leakages generally occur later than greater ones, they have a milder clinical presentation and can be managed conservatively with the use of drain tubes

Il Dosaggio del iPTH come indicatore prognostico di ipocalcemia postoperatoria nei pazienti sottoposti a tiroidectomia totale

L’ipocalcemia è la complicanza più frequente nei pazienti sottoposti a tiroidectomia totale e può presentarsi in forma transitoria, risolvendosi entro 6 mesi dall’intervento, o in forma permanente 1,2. L’incidenza dell’ipocalcemia transitoria varia in letteratura da 1,6% a 50%3, sebbene generalmente contenuta tra il 10- 30%, mentre quella permanente è più rara (1-2%) 4. In genere, l’ipocalcemia insorge nelle prime 24-72 ore dall’intervento.5 Considerando che il rischio di sanguinamento si esaurisce sostanzialmente nelle prime 24 ore postoperatorie 6, l’ipocalcemia costituisce la principale causa di allungamento dei tempi di degenza al fine di permettere un adeguato monitoraggio del paziente. L’utilizzo di parametri predittivi, clinici o biochimici, per l’individuazione dei soggetti a rischio di ipocalcemia e di quelli dimissibili precocemente ed in sicurezza dopo tiroidectomia è argomento di ampio dibattito in letteratura, in particolare riguardo all’utilizzo a tale scopo del dosaggio ematico del paratormone intatto (iPTH). Questo studio mira a valutare in maniera prospettica l’utilità del iPTH ematico dosato 1 ora dall’intervento di tiroidectomia totale, come indice di predittività di una eventuale ipocalcemia postoperatoria e quindi la sua possibile applicazione nella pratica clinica