Exosomes and Signaling Nanovesicles from the Nanofiltration of Preconditioned Adipose Tissue with Skin-B® in Tissue Regeneration and Antiaging: A Clinical Study and Case Report.

Background and Objectives: This three-year clinical trial aimed to demonstrate that only the signaling vesicles produced by ADSCa, containing mRNA, microRNA, growth factors (GFs), and bioactive peptides, provide an advantage over classical therapy with adipose disaggregate to make the tissue regeneration technique safer due to the absence of interfering materials and cells, while being extremely minimally invasive. The infiltration of disaggregated adipose nanofat, defined by the Tonnard method, for the regeneration of the dermis and epidermis during physiological or pathological aging continues to be successfully used for the presence of numerous adult stem cells in suspension (ADSCa). An improvement in this method is the exclusion of fibrous shots and cellular debris from the nanofat to avoid inflammatory phenomena by microfiltration. Materials and Methods: A small amount of adipose tissue was extracted after surface anesthesia and disaggregated according to the Tonnard method. An initial microfiltration at 20/40 microns was performed to remove fibrous shots and cellular debris. The microfiltration was stabilized with a sterile solution containing hyaluronic acid and immediately ultrafiltered to a final size of 0.20 microns to exclude the cellular component and hyaluronic acid chains of different molecular weights. The suspension was then injected into the dermis using a mesotherapy technique with microinjections. Results: This study found that it is possible to extract signaling microvesicles using a simple ultrafiltration system. The Berardesca Scale, Numeric Rating Scale (NRS), and Modified Vancouver Scale (MVS) showed that it is possible to obtain excellent results with this technique. The ultrafiltrate can validly be used in a therapy involving injection into target tissues affected by chronic and photoaging with excellent results. Conclusions: This retrospective clinical evaluation study allowed us to consider the results obtained with this method for the treatment of dermal wrinkles and facial tissue furrows as excellent. The method is safe and an innovative regenerative therapy as a powerful and viable alternative to skin regeneration therapies, antiaging therapies, and chronic inflammatory diseases because it lacks the inflammatory component produced by cellular debris and fibrous sprouts and because it can exclude the mesenchymal cellular component by reducing multiple inflammatory cytokine levels.

Incarcerated Amyand's hernia Personal experience and literature review.

The finding of vermiform appendix in an inguinal hernia is called Amyand's hernia. Two cases of a 30 days and 4 months old children respectively are presented; they had been visited a month earlier and scheduled for inguinal herniotomy in elective surgery. On admission both the patients presented a non-reducible mass in the right inguinal region. Surgical exploration was performed under general anaesthesia. Inguinal canal is opened through transverse lower abdominal skin incision. We palpated a tubular swelling, of tense-elastic consistence through swollen cremaster muscle and hernial sac. Separating cremaster muscle, we opened swollen hernia sac and we found the vermiform appendix, not inflamed. We easily reduced the appendix into the peritoneum cavity, and then we performed the herniotomy according to the Mugnai-Ferrari technique. No post-operative morbidity was reported. The patients was discharged in the first postoperative. We did not have any doubt about avoiding appendectomy in both cases presented; in fact such an intervention, especially in so young patients, had no pathophysiological justification, while it increases the postoperative mortality rate. KEY WORDS: Amyand's hernia, Appendectomy, Inguinal hernia.

Megacolon for a giant faecaloma with unlucky outcome: case report and review of the literature.

We herein report a case of megacolon with fecaloma in an 83-year-old man who presented with constipation, no intestinal occlusion, and a left hydroureteronephrosis, with A.S.A. 4. The patient asymptomatic, was treated Primariely with laxatives. During the conservative therapy the patient presented an abrupt abdominal distension with a bowel obstruction and abdominal compartment syndrome. After the laparotopy and a Hartmann left colon resection the patient died for cardiovascular and metabolic complications. The aim of this report is to give a brief review of this entity and discuss the treatment options for these cases.

[Single incision laparoscopic cholecystectomy: preliminary experience]. / Colecistectomia laparoscopica con singola incisione (S.I.L.S.). Esperienza preliminare.

INTRODUCTION: The Authors describe our preliminary experience with the cholecistectomy with the S.I.L.S. (Single Incision Laparoscopic Surgery), with a multilumen trocar and dedicated laparoscopic instruments. MATERIALS AND METHODS: Five operations of laparoscopic cholecistectomy with S.I.L.S. technique (3 men and 2 women), of age between 26 and 52 years are reported. RESULTS: In one case was applied an additional 5 mm trocar in the right ipocondrium; in two cases a transparietal suture to suspend the gallbladder was used. Operative time was 98 minutes for the first operation, and 45-65 minutes for the following. The operators have been some difficulties to moving the instruments because both the operating instruments and laparoscope are introduced through the same incision and on the same axis, the operator and assistant often impede the movements of each other. Any post-operative complications was registered. All the patients was very satisfied with post-operative pain and aesthetic results. CONCLUSIONS: The S.I.L.S. is a new technique already used in general surgery, urology and ginecology with good results; this surgey is probably destinated to improve his tecnique and instruments, but certainly it going to offer a further push of the mini-invasive "philosophy".