Orthotopic vascularized lymph node transfer in breast cancer-related lymphedema treatment: Functional and life quality outcomes.

INTRODUCTION: Breast cancer-related lymphedema (BCRL) is a chronic disease that occurs up to 65% of breast cancer survivors. Traditional treatment is conservative, but new surgeries as lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are at disposal. This study aims to investigate the orthotopic VLNT efficacy in BCRL. Results in terms of limbs' reduction rates and quality of life improvement are compared with the outcomes reported in Literature. PATIENTS AND METHODS: During patients' selection, inclusion criteria were monolateral ISL stage II or III BCRL with pathologic lymphoscintigraphy imaging and a minimum of previous 6 months of unsuccessful conservative treatment. Bilateral lymphedema, local recurrence or systemic metastasis, acute infection of the limb and deep venous trombosis were exclusion criteria. Surgery consisted in VLNT from the gastroepiploic region to the axilla with axillary scar dissection. RESULTS: From August 2019 to December 2021, 25 patients were included. At the preoperative scintigraphy exam, mean lymph transport index (TI) was 30 (range; 22.7-29.3). Nine of them (36%) were ISL stage II and 16 (64%) were stage III. Average follow-up was 13.5 months (range; 12-19 months). VLN flaps' survival rate was 100%. One year after surgery, the mean Circumferential Reduction Rate (CRR) resulted 44.62 (range; 27.4-60.3). Infections' rates presented a statistically significant reduction, from an average of 2.4 (range; 1-4) to 0.2 (range; 0-1) episodes per year. Life quality index measured with the LYMQOL questionnaire showed significant improvement after 1 year, from a mean score of 3.28 (range; 2-5) to 8.12 (range; 7-9). CONCLUSION: When compared with Literature evidence, the results of the current study are in line with both VLN inset ways related to BCRL treatment. An optimal therapeutic choice should consider benefits and drawbacks of each orthotopic and heterotopic VLNT, taking into account surgeon's preference and experience and patients' related factors and expectations.

Aesthetic Asian double eyelid surgery: Exploring a novel indication for microsurgery.

Asian double eyelid blepharoplasty and medial canthoplasty aim to enhance eye appearance in individuals of Asian descent. Traditional methods have limitations and may cause complications. This study introduces a microsurgical approach, offering improved precision and reduced scarring, applied to 37 patients over six years. While promising, this method requires specialized equipment and training, increasing complexity and cost. Further studies are needed to compare its efficacy with conventional techniques.

Recurrent Extreme Bilateral Gigantomastia Caused by Pseudoangiomatous Stromal Hyperplasia (PASH) Syndrome: A Case Report.

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a rare and benign medical condition in which the breast tissue is affected by an abnormal myofibroblastic proliferation, which mimics a low-grade sarcoma angiomatous proliferation. PASH usually presents itself either as a palpable mass or as an incidental diagnosis during breast specimens' histological examination. A few cases have been reported in the literature of a diffuse form of breast PASH syndrome in which the clinical presentation is a bilateral form of gigantomastia without palpable masses. In such cases, the optimal surgical management is still debated due to a significant risk of relapse after breast reduction. Mastectomy seems to be the endpoint of this condition in relapsing cases. Recent studies report a good outcome with a Tamoxifen regimen when surgery cannot be performed, supporting a hormonal component for the etiology of the condition. This study reports on an extremely rare case of bilateral, rapid, and severe PASH in a young patient, presenting as a truly disabling gigantomastia that forced the patient to use a wheelchair due to the excessive breast weights (25 kg the right breast and 21 kg the left). We describe her complicated medical history, her diagnosis, and our course of treatment.

Congenital high airway obstruction syndrome (CHAOS): discussing the role and limits of prenatal diagnosis starting from a single-center case series.

OBJECTIVES: we aimed to report our experience about congenital high airway obstruction syndrome (CHAOS) that is a rare and fatal congenital anomaly; laryngeal atresia is the most frequent cause. Sonographic findings are enlarged echogenic lungs, dilated trachea, and ascites. METHODS: we performed a single-center case series analysis collecting antenatally through ultrasound examination, and some of them confirmed by autopsy. RESULTS: we report six cases of CHAOS diagnosed by antenatal ultrasonography between 2007 and 2013. CONCLUSION: to date literature provides very few individual case reports. This work describes typical sonographic findings of this syndrome and it underlines the importance of early prenatal diagnosis to improve prognosis thought an ex utero intrapartum treatment, that seems to be the only chance of survival for the affected fetus.

Ultrasound prenatal diagnosis of congenital primary aphakia: case report.

INTRODUCTION: the ultrasound prenatal diagnosis of aphakia is a difficult diagnosis and often requires a genetic study of the karyotype. CASE REPORT: we present a rare case of prenatal bilateral aphakia, confirmed after bird. The patient was observed by ultrasound during the 23rd week of pregnancy. Through transabdominal ultrasound the lens could not be visualized bilaterally. The remaining anathomy, explorable by ultrasound, was still regular. When aphakia is suspected, genetic counseling is essential. CONCLUSION: a differential diagnosis between aphakia and anophtalmia is necessary. A TORCH complex evaluation can be useful. Amniocentesis is always required.

Antenatal diagnosis of Seckel Syndrome: a rare case report.

INTRODUCTION: Seckel Syndrome is a rare autosomal recessive disorder characterized by dwarfism, microcephaly and the absence of visceral malformations. CASE REPORT: we observed sonographic features of a Seckel Syndrome, in a patient during the 24th week of pregnancy. Her family history was negative for malformation and chromosomal disorders. The diagnosis was later confirmed by molecular tests. CONCLUSION: diagnosis should be made only by expert operators. Karyotype analysis is essential to confirm the diagnosis.